Pneumoencephalos after Inadvertent Intrathecal Air Injection during Epidural Block

Pneumoencéfalo após anestesia peridural: relato de caso

“…Ainalação de oxigênio a 100% é recomendada, uma vez que possibilita a captação do nitrogênio do ar coletado 25,26 . Ao contrário, a inalação de óxido nitroso aumenta o volume gasoso com agravamento do quadro e, portanto, seu uso deve ser evitado, quando o ar foi utilizado para a identificação do espaço peridural 27,28 . Neste caso, a paciente não referiu cefaléia.…”

“…Inhalation of 100% oxygen is recommended for allowing the uptake of collected air nitrogen 25,26 . Conversely, nitrous oxide inhalation increases gaseous volume thus worsening the situation and its use should be avoided when air is used to identify the epidural space 27,28 . In our case, patient did not refer headache.…”

A reply

“…Firstly, may we comment on the evidence against the LORA technique? In the 10 references claiming increased adverse effects from LORA, seven were from an obstetric population [2][3][4][5][6][7][8], two were chronic pain patients [9,10] and one was in paediatric patients [11]. The patients in all but one article had lumbar epidurals.…”

“…The patients in all but one article had lumbar epidurals. Five references discuss serious complications of LORA, namely pneumocephalus [4,5], venous air embolism [6], spinal cord compression [9] and multiradicular syndrome [10]. However, all cite the use of 5-20 ml of air and in some cases describe multiple attempts at epidural insertion.…”

“…Both the Wisconsin [4] and UNOS [5] criteria have been evaluated and provide a reasonable prediction for whether a patient will be suitable for NHB organ donation. Using these or similar criteria will help to identify potential donors and thereby decrease the risk of seeking unnecessary consent from an already distressed and grieving family.…”