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The calm before the storm: haemorrhagic cardiac arrest during lumbar disc surgery

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Euroanaesthesia 2017

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Abstract

BACKGROUND Lumbar disc surgery is very common in neurosurgery. Although several surgical complications could be happened during the approach to the disc, hemorrhage due to vascular injuries is rare (0.010.05%) and underhanded event1. Here we report a case of hemorrhagic cardiac arrest due to vascular injury follow lumbar disc surgery. CASE REPORT A 53yearold female underwent lumbar disc surgery for a disc protrusion (L5S1 level). During the closure phase of the surgery time the patient became bradycardic and unresponsive to atropine. Suddenly carbon dioxide curve decrease to 10 mmHg, the plethysmography curve disappeared and noninvasive blood pressure was immeasurable. The final neurosurgery phase was interrupted and the patient was rapidly turned to the supine position. She was pulseless so advanced cardiac life support maneuver were started.The abdomen was distended so intraabdominal bleeding was suspected and vascular surgeon alerted.After opening the retroperitoneal space and evacuation of the hematoma, a 3 mm of right iliac artery laceration were founded.The laceration was repaired with double overlook suture.The cardiac massage was protracted for fiftyfive minutes. It was stopped just ten minutes after the vascular surgery reparation.Valid pulses were founded sustained by a continuous infusion of adrenaline. An overall of 18 mg of adrenaline, 4 mg of atropine, one liter of colloid, six unit of fresh frozen plasma, one unit of platelets and eleven units of whole blood were administered to the patient.The patient was sent to intensive care unit were the next day regained consciousness and motility.She was rapidly extubated and three day after descharged to neurosurgical ward. DISCUSSION The lesions of the large pelvic vessels are described more often when working on the intervertebral space L4L5 or L5S1 because at this level the great vessels are relatively "real estate" and very close to each other (Fig 1).The most dramatic context is obviously an arterial laceration. In these cases you can get in a short time to hemorrhagic shock, with a mortality rate up to 80% to 100%.1The most often affected vessel is the left common iliac artery, which lies immediately in front of the fourth intervertebral disc. REFERENCES Papadoulas S et al. Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg 24:18995,2002 LEARNING POINTS Anesthesiologists should be aware of the risks of vascular injury follow lumbar disc surgery.

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© Copyright 2019 Morressier GmbH.
All rights reserved.