Changes in pressure in the vertebral tube - 1 case of serious complications of anesthesia in the vertebral tube

Intra-vertebral anesthesia is the drug bureau drug, opioids injected into a cavity in the vertebral tube, so that the bureau hemp drug action on the spinal nerve root and cause the corresponding parts to produce anaesthetic effect, reversible blocking the spinal nerve conduction function or reduce its excitability of an anaesthetic method, the anaesthetic mode is simple to operate, good effect, small trauma to patients, often used in plastic surgery, obstetrics, gynecology and other surgical procedures of anesthesiaintravertebral anesthesia includes three types of cobweb subcavity block (also known as lumbar line), epidural outer cavity block (also known as epidural anesthesia) and lumbar-hard joint anesthesiaComplications of intravertebral anesthesia refer to adverse reactions to the body due to drug action or technical operation, and headache (PDPHA), low back pain and nausea and vomiting (PONV) are common types of anesthesia complicationsThe specific treatment of one patient with intravertebral anaesthetic complications admitted to our hospital on April 1, 2018 in the department is reported below1clinicalinformationpatient, male, 77 years old, admitted to the clinic with "mixed symmy, constipation"30 years ago, the patient has no obvious cause of the appearance of the swelling out, then can be self-recalled, paper with blood, self-use drugs (specific unknown) after the symptoms reliefAfter the above symptoms intermittent attack, there is no formal treatmentThere was no obvious cause of exacerbation of the symptoms before 6 monthsAdmission specialist body: center, appearance without malformation, cutstone bit clockwise 3, 8 to 9, 12 points of the skin bump, color brown, soft, no touch pain; mirror show: the tooth line rectum vicosus membrane 1, 3, 5, 7, 9, 11 point of charge, protrusion, fat, no blood seepage, and the corresponding external sie fusion to form a mixed slugPreliminaryDiagnosis:(1) Chinese medicinediagnosis : sickness, wet heat betting certificate; blood routine: white blood cell 8.2 x 109/L, neutrophil count 6.48 x 1012/L, centophilia percentage 79%, red blood cell 4.71 x 1012/L, hemoglobin 157g/L, platelet 126 x 109/L The patient was highly neutral and treated anti-
infection after surgery Blood clotting function is basically normal mirror show: the tooth line rectum vicosus membrane 1, 3, 5, 7, 9, 11 point of charge, protrusion, fat, no blood seepage, and the corresponding external sie fusion to form a mixed slug Random blood sugar: 10.8mmol/L, the final western medical diagnosis results are lumbar vertebral stenosis, intratube occupatic (epidural (under) the possibility of hematoma), lumbar degenerative lateral protrusion, mixed vertebral degenerative lateral protrusion, lumbar disc protrusion, T12 vertebral extrus ion fracture, left lower limb intramuscular venous thrombosis , rectoric intestinal polyps, prostate hyperplasia therapy: anesthesia and surgical methods: rectal mucosal cyclosis (SPH), intracobrillation injection seissurgery under the joint rebutular anesthesia After anesthesia, the patient takes the cut stone position, routinely disinfects the anal and vulva skin, lays the surgical towel, disinfects the anal tube and the lower part of the rectum Expand the anus with a circular mirror, place and secure three windows transparent mirror under its guidance, use 1-0 absorbable line in the tooth line with 1-0 absorbable line in the tooth line clockwise 1 to 3, 5 to 7, 9 to 11 o'clock line a circle of intermittent single bag stitching, will nail drill drill Head into the anus, placed in the lotus line, tighten the load and tie, the lotus wire traction out the traction hole knot, screw the match, hit the hair, wait for 30s, slowly remove the matcher; The examination found that the 11-point "ear" ligation area slightly blood seepage, to 4-0 absorbable line stitching to stop the bleeding Remove the transparent mirror after fine examination without bleeding With small bend clamps clamps 1, 3, 5, 7, 9, 11 points inside the core, with 1:1 to eliminate the spirit, Lidoca in injection of fan injection to mucous membrane filling checked without obvious bleeding, the oxymeyminfuraan aurda anus, shell polysaccharide gel plug, gel sponge, purple grass oil yarn plug, tower-shaped gauze pressurized fixed, take a delivery pathology examination within the tissue Postoperative treatment: to oxygen absorption, electrocardiogram, blood oxygen monitoring, static drop sulphate amika star prevention infection and rehydration support and other treatment Patients complain edging back pain discomfort after surgery, no dizziness, eyes, chest tightness and other discomfort, press the pain of the anaesthetic site is even more, consider the effects of anesthesia operation, give aceclayrate intestinal tablets after the pain relief slightly The patient's left lower limb is numb, weak, left lower limb muscle strength level 1, considering that the reason is the intra-vertebral anesthesia after epidural hematoma, spinal nerve root damage, intervertebral disk protruding compression of the spinal nerve root diagnosis showed that the pressure of nerves in the vertebral tube was highly likely, eliminating the occurrence of epidural hematoma Give glycol, dexamethasone static drops to reduce the pressure in the vertebral tube, while the puncture pumping relieves nerve root compression In the C-arm precise positioning, in the most obvious area of gas with the 5th waist needle through the lumbar L2 to L3 vertebral gap puncture to reach the epidural outer cavity, pumping out the gas about 0.5 ml, the whole operation process is smooth, no entry vascular and cobweb subcavity signs, patients without special discomfort, exit waist needle after transparent application covering piercing point, safe back to the ward The patient is instructed to continue to lie flat and rest Blood pressure measurement 160/90mmHg, patients without obvious dizziness, headache symptoms, to nitrobenzene flat release tablet 10mg oral blood pressure treatment, postoperative blood pressure fluctuations in 130 to 170/ 65 to 100mm, patients have no hypertension history, normal blood pressure in hospital, but do not rule out hypertension the possibility of the current reduction of nitrobenzene lumbar vertebrae MRI show: (1) T10 to L1 section of the vertebral tube inside the back shuttle and linear abnormal signal, epidural (below) hematoma may, it is recommended to combine CT examination (2) L2/3, L4/5 intervertebral disc degeneration, L3/4, L4/5, L5/S1 intervertebral disc protrusion (L4/5 disc protruding for) and the vertebral tube is obviously narrow (3) T12 vertebrae old compression (4) Lumbar vertebral hyperplifying (5) Lumbar structure is unstable, L4 vertebrae I before slip (Figure 1) After the whole hemp down the back road through the back road T10 to L1 vertebral plate removal, vertebral tube decompression, epidural hematoma removal, self-inflicted bone implants, after surgery transferred to ICU to continue treatment Figure 1 Lumbar MRI sacrotum scan 2 Discussion of hematoma, emphysema and spinal cord injury are common complications of intravertebral anesthesia After anesthesia, hematoma in the outer cavity of the endoscopic lining of the vertebral tube, which compresses the spinal cord, is a serious complication that endangers the safety of patients Therefore, those who intend to choose intravertebral anaesthetic, before surgery need to inquire in detail about the medical history, especially whether there is blood system and anticoagulant history, carefully check the body, whether there is spinal malformation and so on The study confirmed that the patient's age, type of surgery, surgery time, whether or not to develop infectious diseases, bleeding volume, whether to combine diabetes and whether to combine hypertension, is a risk factor for serious complications of intravertebral anesthesia Dexamethasone's method of administration, type of surgery, amount of bleeding, whether or not to combine hypertension, is an independent risk factor for headache occurring after intraoperative anesthesia Dexamethasone is a separate influence factor of headache after intra-vertebral anesthesia, and can reduce the risk of headache after intravertebral anesthesia In order to reduce the occurrence of headache after intravertebral anaesthetic, patients should receive a moderate amount of cemesone treatment before surgery compared with normal people, T12 vertebral fractures, lumbar vertebral stenosis patients are more prone to traumatic spinal epidurals, external hematoma Therefore, for preoperatively diagnosed patients with strong spinal itis, it is best to avoid the choice of intravertebral anesthesia For the epidural puncture after sudden sensation of back pain, to immediately find out the cause, timely check the movement and sensory function of the double lower limbs, as soon as possible to the patient MRI, CT imaging technical examination At present, the important diagnostic means of epidural hematoma is MRI, MRI on the soft tissue of the vertebral tube to identify the performance is good, can clearly show the endofor hematoma site, range size and the change of the spinal cord after pressure, can distinguish between the epidural hematoma and epidural tumor, spinal cord epidural hematoma patients with acute hematoma showed high density shadow shape, while patients with acute conditions often showed uneven CT imaging density Therefore, after the patient receives epidural anesthesia, the medical staff must time lying on the patient follow-up, the symptoms of epidural epidural hematoma timely detection and formulation of treatment and prognosis program, to avoid the occurrence of serious complications such as paraplegia In this case, the patient's shallow left lower limb decreased during treatment, considering that the possible cause of occurrence is anaesthetic in the vertebral tube after epidural hematoma or spinal nerve root injury or intervertebral disc protrusion compression of the spinal nerve root the lumbar CT test to indicate that the gas build-up in the vertebral tube is highly likely to compress the nerve In the most obvious vertebral gap puncture in the gas to reach the epidural cavity, extraction of gas, the patient gas build-up significantly reduced PanniMK and so on pointed out that when the epidural gas 4 to 6 ml, did not cause a significant sign of spinal cord compression, but in the performance of ultra-long feeling and movement blocking Li Xionggang's research shows that the gas in the epidural cavity causes a high-pressure environment, causing the high spinal cord direct pressure, peripheral respiratory failure, spinal ischemia, the patient ultimately rescue invalid death Guo Shengdong and others analyzed the causeof semama of the epidural epidural of the epidural of 1 patient, ruled out the cause of anesthesia operation, and, according to its medical history and imaging characteristics, finally agreed that the patient was a spontaneous intradural hematoma There are many factors that cause epidural hematoma, which are broadly divided into: (1) internal causes: there are blood clotting disorders, intra-vertebral vascular malformations, hypertension, diabetes , arteriosclerosis, pulmonary hypertension, pregnancy, etc.; Although the time of coagulation is normal, the patient in this case cannot rule out the possibility of abnormal coagulation function or the existence of other blood system diseases This case patient seispenses the effects of anesthesia operation and past medical history during treatment, but the patient's T12 vertebral archaic fracture treatment process, epidural hematoma occurred in T10 to L1, which may be related to T12 lesions, do not rule out spontaneous epidural hematoma vertebral tube and vertebral volume gas (air bubble, AB) occur in the lower thoracic and upper lumbar vertebrae in a larger proportion, we consider clinical on the T11, T12 and L1, L2 vertebral OPF incidence is higher It can be seen that most of the gas build-up occurs in the vertebral tube and in bone cement (94.7%) The gas build-up in the vertebral tube is mainly distributed in the front of the vertebral tube behind the vertebrae, accounting for about half of the total number of gas patients In this case, the vertebral tube in the course of treatment in a small amount of gas, the doctor told the patient to lie flat to rest, to glycol, dexamethasone static drops to reduce the pressure, vitamin B1, B12 static drops of nutrient nerve Lumbar disc protrusion (lumbar disc hemiatio) is a pain-like syndrome caused by the irritation and compression of the nerve caused by myelin protruding from the ruptured fiber ring Imaging examination methods are the main way of diagnosis and treatment of lumbar vertebral diseases The results of the lumbar CT examination showed that the patient had lumbar disc protrusion, T12 vertebral archeaic fracture, lumbar vertebral stenosis and lumbar degenerative lateral protrusion patients with left lower limb edema, MRI examination confirmed as a vein thrombosis between the left lower limb muscles, considering the patient's postoperative left lower limb vein thrombosis, but not completely blocked blood vessels, the vertebral tube occupied (epidural outside (under) ) hematoma is very likely, it is recommended that patients as early as possible intravertebral intratube decompression treatment Full hemp downstream through the back road through the back road T10 to L1 vertebral plate removal, vertebral tube decompression, epidural hematoma removal, self-inflicted bone implantation, after surgery transferred to ICU to continue treatment prevention and treatment measures: (1) patients with varying time of complications after intravertebral anesthesia should be followed up regularly; (2) epidural or venous analgesics will confuse the discovery of complications, so that once the changes in peripheral neurology are found should stop pain relief in time, closely observe the patient's condition; (3) this complication should be given dehydration, corticic, eglutol and neurotrophic drugs and other comprehensive treatment; Changes in the , continue to prevention infection, nutritional nerves, dehydration and swelling, protection stomach mucosa, coughing sputum treatment, review the chest waist MRI examination; (6) Patients in the course of treatment should be a moderate amount of activity of the lower limbs, intravenous fluids to stop bleeding, prevention of infection and so on