게시판
| 21KS-011 |
Cardiac arrest after thoracic epidural injection
Department of Anesthesiology and Pain Medicine, Seoul St. Mary s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Introduction
Epidural injection is a common procedure in the pain clinic. Common minor complications include pain at the injection site, and vasovagal reactions. Serious complications reported in the literature include respiratory depression, subdural hematoma, and cardiac arrest. We report a case where cardiac arrest occurred after epidural injection.
Case report
A 54-year-old woman with hypertension who underwent total laminectomy c6-T3, posterior screw fixation C6-T2 with tetraplegia due to OPLL C5-T2 in NS visited Pain clinic 10 months ago. The patient complained of back pain of 9-10 points of NRS. Epidural injection(T6-T7, T7-T8) were performed several times, but continuously complaining of pain NRS 9. Epidural injection in T2-T3 was performed twice four and two months ago, and block had effects, so, a third epidural injection was performed in the same way. Under the c-arm guide, the needle was approached toward T2-T3, and contrast medium was injected after LOR with air was confirmed. After visualization, the patient was injected with total volume 5mL of 2% lidocaine. The patient was placed in a recovery room bed and vital signs were measured after applying oxygen. Soon, the patient became unconscious and the heart rate slowed down to 30 times and stopped. Cardiopulmonary resuscitation was performed immediately. 7 minutes of CPR was performed and the heart rate returned to normal, but remained unconscious. After ROSC, the patient was moved to the ICU and the targeted temperature management was performed according to the ACLS. After the 5th day, she was opening eyes on verbal command. On the 8th day, intubation tube was removed, and on the 10th day, consciousness returned and transferred to a general ward. On the 30th day, the vital signs were stable, the patient was alert, and the limb muscle strength reached previous level. She was discharged from the hospital.
Conclusion
It is known as the mechanism in which arrest occurs after epidural injection, such as vasovagal response, blockade of cardiac accelerator nerve(T1-T4), and total spinal block. Epidural injection has low incidence of serious complications because of its well established protocol, but if arrest occurs, it would be a disaster for patients. This case might suggest that it is necessary to closely observe the vital signs of the patient after epidural injection.
Epidural injection is a common procedure in the pain clinic. Common minor complications include pain at the injection site, and vasovagal reactions. Serious complications reported in the literature include respiratory depression, subdural hematoma, and cardiac arrest. We report a case where cardiac arrest occurred after epidural injection.
Case report
A 54-year-old woman with hypertension who underwent total laminectomy c6-T3, posterior screw fixation C6-T2 with tetraplegia due to OPLL C5-T2 in NS visited Pain clinic 10 months ago. The patient complained of back pain of 9-10 points of NRS. Epidural injection(T6-T7, T7-T8) were performed several times, but continuously complaining of pain NRS 9. Epidural injection in T2-T3 was performed twice four and two months ago, and block had effects, so, a third epidural injection was performed in the same way. Under the c-arm guide, the needle was approached toward T2-T3, and contrast medium was injected after LOR with air was confirmed. After visualization, the patient was injected with total volume 5mL of 2% lidocaine. The patient was placed in a recovery room bed and vital signs were measured after applying oxygen. Soon, the patient became unconscious and the heart rate slowed down to 30 times and stopped. Cardiopulmonary resuscitation was performed immediately. 7 minutes of CPR was performed and the heart rate returned to normal, but remained unconscious. After ROSC, the patient was moved to the ICU and the targeted temperature management was performed according to the ACLS. After the 5th day, she was opening eyes on verbal command. On the 8th day, intubation tube was removed, and on the 10th day, consciousness returned and transferred to a general ward. On the 30th day, the vital signs were stable, the patient was alert, and the limb muscle strength reached previous level. She was discharged from the hospital.
Conclusion
It is known as the mechanism in which arrest occurs after epidural injection, such as vasovagal response, blockade of cardiac accelerator nerve(T1-T4), and total spinal block. Epidural injection has low incidence of serious complications because of its well established protocol, but if arrest occurs, it would be a disaster for patients. This case might suggest that it is necessary to closely observe the vital signs of the patient after epidural injection.
