Epidural anestezi sırasında dura delinmesini takiben oluşan akut subdural hematom (Olgu sunumu)

Abstract

A case is reported of an acute intracranial subdural hematoma, following an accidental dural puncture during an epidural anaesthesia. A 36 years old gravida with a gestation of 37 weeks was operated on for caesarean section. An 18 G Tuohy needle was inserted into the L3-4 interspace and an accidental dural puncture occured. The needle was removed and general anaesthesia was applied. Anaesthesia was induced with cisatracurium precurarization (2 mg), thiopentone 5 mg/kg, succinylcholine 100 mg. After delivery of baby, anaesthesia was maintained with 50 % nitrous oxide in oxygen, sevoflurane 1 %, boluses of 0.1 mg fentanyl and 2 mg cisatracurium. On the second day postpartum, the patient described a headache which was started both occipital and neck and relieved by lying down. Conservative treatment with analgesics and IV fluid administration was advised. On the seventh day postpartum, she suffered tonic-chlonic convulsions. At this point, a neurological opinion was thought and a computerized tomography was suggested to determine an intracranial complication. Inspite of different analgesic treatments and normal computerized tomography finding, the patient suffered severe headache following days. For this reason, a magnetic resonance was suggested and it revealed a subdural hematoma (4 mm) in right frontal side. The persisting headache decreased on the twelvth day and relieved on fourteenth day postpartum. Consequently, the presence of postdural puncture complicated by a typical neurological deterioration following epidural anaesthesia should prompt the anaesthesist to seek an immediate clinical and x-ray diagnosis in order to look for the existence of intracra-nial complications.