The Complicated Uncomplicated Epidural Placed Under General Anesthesia: A Complete Spinal in the Post-Anesthesia Recovery Unit

Abstract

Placement of an epidural catheter under general anesthesia in children is associated with more neurologic complications as compared to placement when the patient is awake. The anesthetized patient cannot communicate the symptoms of an intrathecal placement. A 5-year-old boy had an epidural catheter placed after induction of general anesthesia. Negative aspiration of cerebral spinal fluid (CSF) was confirmed. The patient had intraoperative hypotension without bradycardia during the use of the catheter. In the post-operative recovery unit, the patient developed apnea and signs of a high spinal. Intrathecal placement of an epidural catheter is not a rare or unexpected complication of epidural analgesia. However, in an anesthetized child with negative aspiration of CSF combined with the inability of the patient to communicate the signs of a high spinal a delay in diagnosis may occur. Our case report highlights the importance of identifying intrathecal placement of an epidural catheter under general anesthesia.




J Med Cases. 2014;5(11):564-566
doi: http://dx.doi.org/10.14740/jmc1938w