硬脊膜下腔意外置管：硬脊膜外腔麻醉併發症之病例報告

Accidental Subdural Catheterization Due to Complication of Epidural Anesthesia-- A Case Report

意外地硬脊膜下腔麻醉已被確認為硬脊膜外腔麻醉的併發症。本文乃報告於婦產科手術的病例在嘗試硬脊膜外腔麻醉時，意外地將導管置入硬脊膜下腔，並注入局部麻醉劑。其發生過程及放射線影像的表現，將與其他文獻報告硬脊膜下腔注入局部麻醉劑的病例做一比較。當臨床上確定非為脊髓腔內注射，卻有廣泛性感覺阻斷及血壓呼吸不穩定時，應考慮是否為硬脊膜下腔注射。除了維持呼吸及循環至阻斷消失，雖於術後可以放射線檢查確定導管的位置。但因硬脊膜下腔連續注射有其不可預知的危險性，仍建議術中重新於其他位置嘗試硬脊膜外腔麻醉或更改其他麻醉方式。

Although accidental subdural injection is a well-recognized complication of epidural block, only a mere handful cases have been substantially proven by radiological evidence. Here we report a case of subdural catheterization during the attempt of epidural anesthesia for a gynecological procedure. Its clinical course and radiological findings are compared with those of the cases previously reported in literature. Whenever there is the occurrence of widespread of sensory block together with respiratory distress and hemodynamic unstability following epidural injection of local anesthetic, a subdural injection should be considered in spite of a negative confirmation. Repeated subdural injection of a local anesthetic at the same site may predispose patients to serious morbidity. Therefore, we recommend that when a subdural injection is evident or suspected, reinsertion of the catheter in the epidural space via another entry or contemplation of a switch to another anesthetic technique is mandatory.