Pneumothorax associated with epidural anesthesia

Abstract

paramedian approach at the level of the Th 7 -Th 8 interspace. After contacting the vertebral lamina, the angle of the needle was adjusted to identify the epidural space. The Tuohy needle was directed at an angle of 45°t o cephalad, and, presumably, less than 15° toward the midline. A loss-of-resistance technique, using a salinefilled glass syringe, detected a likely space at a depth of 6 cm from the skin. A test aspiration was done with the syringe to confirm negative blood or cerebrospinal fluid, when air was aspirated unexpectedly. At that moment, the patient leaned slightly toward the resident. Although no symptom of pneumothorax, such as respiratory distress or decreased breath sounds, was observed, the needle was withdrawn. The other, experienced, anesthesiologist tried to insert the epidural needle via the left paramedian approach at the level of the Th 8 -Th 9 interspace after adjusting the patient's position, but without changing it to another position. The Tuohy needle was introduced 1.0 cm laterally from the midline. After contacting the lamina, "walking" on the lamina facilitated the loss-of-resistance feeling obtained at a depth of 6 cm from the skin. The angle of the needle was then about 45° to cephalad, and 15° toward the midline. A test dose of 3 ml of 2% lidocaine was injected from the epidural catheter. Bilateral Th 7 -Th 9 thermal hypesthesia was confirmed 5 min later with cold test. Subsequently, general anesthesia was induced with intravenous fentanyl, 100 µg; propofol, 90 mg; and vecuronium, 9 mg. To achieve left-sided one-lung ventilation during the right bullectomy, a single-lumen endotracheal tube with a bronchial blocker was intubated. Anesthesia during one-lung ventilation was maintained with sevoflurane, 70% oxygen in nitrogen and intravenous fentanyl, and appropriate oxygenation and carbon dioxide elimination were maintained. The anesthesia and operative procedure were then uneventful.A routine postoperative chest radiograph, to verify proper pulmonary expansion, was taken about 4 h after the first attempt at inserting the epidural catheter, and it

Bilateral Pneumothoraces Following Central Venous Cannulation

“…Two days earlier, the patient has undergone a combined anesthesia including the epidural insertion of a catheter. A few cases of accidental puncture of the lung after thoracic epidural anesthesia have been reported, generally using a thoracic paramedian approach [2, 3]. In our case, the epidural catheter was inserted into the lombar interspace (L1-L2) using a median approach.…”

Cough during Thoracic Epidural Insertion: What to Do?

“…The outcome of such a complication is variable. It may go unnoticed and uneventful or may lead to serious complications such as hemothorax [4], or pneumothorax [5]. Although pleural puncture is more common with paramedian approach incidences with the median approach has also have been reported [6].…”

Epidural catheter misplaced into the thoracic cavity: Utilized to provide interpleural analgesia

“…It may go unnoticed and uneventful or may lead to serious complications such as hemothorax[ 5 ] or pneumothorax. [ 6 ]…”