高齡病患接受硬脊膜外麻醉之管路打結－－病例報告

Epidural Catheter Knotting in An Elderly Patient - A Case Report

硬脊膜外麻醉為現今普遍使用的麻醉法之一，因它還能提供良好的術後止痛途徑。但有些罕見的併發症，如硬膜外導管打結導致移除時的困難，甚至帶手術介入造成麻醉醫師的困擾。此類管路打結報告大多是產姆，本篇報告一位泌尿科的老年病患在嘗試移除導管時發現困難，最後利用改變病患姿勢並穩定輕柔的外拉將導管移除。結論是硬膜外導管置放在硬脊膜外腔的長度應少於5公分，尤其對老年病患使用較軟的導管時應特別小心，因為發生打結的機率可能會較高。

Epidural anesthesia is a widely used technique in current anesthesia practice. It offers a valuable additional function, postoperative pain control. Some rare complications such as entrapment and knotting might happen during remove of the epidural catheter. It is a great challenge to anesthesiologists and may need surgical intervention. Knotted and entrapped catheters were mostly described in obstetrics. We reported a nonobstetric elderly patient with difficulty in removing a 20-guage soft epidural catheter (Perifix®, Soft 501 filter set, B.BRAUN). In this case, the catheter was successful removed with steady gentle traction by changing patient's position. The conclusion was that the catheter length left in epidural space should be less than 5 cm, and the possibility of epidural knotting was higher when soft catheter was used in old age patient.