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Sep 3, 2019

The European Society of Regional Anaesthesia and Pain Therapy 2019

IATROGENIC PNEUMOCEPHALUS AND HYPERBARIC OXYGEN THERAPY: A CASE REPORT

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pneumocephalus

hyperbaric oxygen therapy

epidural catheter

accidental dural puncture

neurologic symptoms

Abstract

Abstract

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Keywords

pneumocephalus

hyperbaric oxygen therapy

epidural catheter

accidental dural puncture

neurologic symptoms

Abstract

Background and Aims: Pneumocephalus is a rare but potentially serious complication of epidural block. Hyperbaric oxygen therapy (HBOT) accelerates the air absorption in patients with persistent and symptomatic pneumocephalus, leading to clinical and radiological improvement. Methods: A 79-year-old male with multiple comorbidities was scheduled for left radical nephrectomy and vesical transurethral resection due to malignant neoplasm. Surgery was performed under combined epidural and general anesthesia. Epidural catheter was difficult to place. A first attempt at L3-L4 with loss-of-resistance to saline technique resulted in an accidental dural puncture at 3cm from skin surface. The catheter was then placed at L4-L5 with loss-of-resistance to air technique. It was used intraoperatively without complications. As previously scheduled, the patient was admitted in the ICU, stable and without neurological signs. Epidural infusion was started using a 50mL infusion syringe system with 1,3mg/mL levobupivacaine and 40mcg/mL morphine at 2mL/h. Within 2h, the patient developed confusion/agitation (RASS+2), vertical nystagmus and paraparesis (RIM2; LIM1). Cranial CT showed gaseous foci in both frontal and temporal regions, suggesting pneumocephalus. Results The patient underwent an 8h HBOT session with total resolution of his deficits. He was discharged on the 7th postoperative-day, with no other complications. Conclusions: Pneumocephalus should be considered in the presence of neurological symptoms following an epidural technique. HBOT is an effective approach for this complication.

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© Copyright 2019 Morressier GmbH.
All rights reserved.