Abstract
Deux cas de cathéters placés accidentellement dans l’espace sousdural l’un à la suite d’une rachianesthésie continue et l’autre lors d’une anesthésie péridurale continue sont présentés et discutés dans ce travail. Dans le premier cas, malgré un reflux aisé de 5 ml d’un liquide eauderoche par le cathéter et l’injection de 4 ml de bupivacaine 0.5 pour cent adrenaline 1:200’000 puis de 3 ml de tétracaine 0,5pour cent, l’anesthèsie s’est soldée par un échec. Dans le deuxième cas, malgré l’administration de 20 ml de lidocaïne deux pour cent CO2 adrenaline 1:200’000 et de 10 ml de bupivacaïne 0,5 pour cent, l’anesthesie est restée insuffisante, essentiellement sensitive, asymetrique et morcellée en plusieurs territoires. Les manifestations cliniques de ces deux cas sont discutées et comparees aux observations rapportées dans la littérature. L’importance de la technique radiologique pour confirmer le diagnostic est soulignée.
Abstract
Two cases of subdural catheter placement following continuous spinal and continuous epidural anaesthesia are presented. In the first, despite an easy reflux of clear cerebrospinal fluid through the catheter, the injection of 4 ml bupivacaïne 0.5 per cent with epinephrine 1:200,000 followed by 3 ml tetracaïne 0.5 per cent showed a failure of spinal anesthesia. In the second, the administration through the catheter of 20 ml lidocaine 2.0 per cent CO2 plus epinephrine 1:200,000 and often ml bupivacaïne 0.5 per cent lead to an insufficient, patchy and assymetrical analgesia. The clinical signs observed in these two cases are compared with previous publications. The importance ofanxray contrast study to confirm the diagnosis of subdural catheter insertion is stressed.
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Bibliographie
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Mocan, M., Gamulin, Z., Klopfenstein, C.E. et al. Cathétérisme accidentel de l’espace sousdural: complication de la rachianesthésie continue et de l’anesthésie péridurale continue. Can J Anaesth 36, 708–712 (1989). https://doi.org/10.1007/BF03005427
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DOI: https://doi.org/10.1007/BF03005427
Mots clés
- Technique D’anesthésie: péridurale, rachidienne
- Complications: migration du catheter, injection sous-durale