Case report: Subdural anesthesia in the obstetric patient
Introduction: Subdural anesthesia is a relatively frequent complication though seldom recognized. It has a broad spectrum of presentations ranging from an unexpectedly high sensory block with limited motor block, to substantial hemodynamic and respiratory involvement.
Case presentation: A 22-year old woman undergoing cesarean section under epidural anesthesia with evidence of long-lasting higher than expected sensory block and respiratory distress.
Conclusion: Neuraxial anesthesia comprises a number of versatile and safe techniques, though not exempt from complications including subdural anesthesia. We should be aware of this possibility in our clinical practice, know the risk factors and the diagnostic criteria.
2. Lubenow T, Keh-Wong E, Kristof K, Ivankovich O, Ivankovich AD. Inadvertent subdural injection: a complication of an epidural block. Anesth Analg. 1988;67:175-9.
3. Jenkins JG. Some immediate serious complications of obstetric epidural analgesia and anaesthesia: a prospective study of 145,550 epidurals. Int J Obstet Anesth. 2005;14:37-42.
4. Mehta M, Salmon N. Extradural block. Confirmation of the injection site by X-ray monitoring. Anaesthesia. 1985;40:1009-12.
5. Hoftman N. Unintentional subdural injection: a complication of neuraxial anesthesia/analgesia. Anesthesiol Clin. 2011;29:279-90.
6. Agarwal D, Mohta M, Tyagi A, Sethi AK. Subdural block and the anaesthetist. Anaesth Intensive Care. 2010;38:20-6.
7. Haines DE. On the question of a subdural space. Anat Rec. 1991;230:3-21.
8. Fettes PDW, Jansson J-R, Wildsmith JAW. Failed spinal anaesthesia: mechanisms, management, and prevention. Br J Anaesth. 2009;102:739-48.
9. Reina MA, De Leon Casasola O, López A, De Andrés JA, Mora M, Fernández A. The origin of the spinal subdural space: ultrastructure findings. Anesth Analg. 2002;94:991-5.
10. Haines DE, Harkey HL, al-Mefty O. The "subdural" space: a new look at an outdated concept. Neurosurgery. 1993;32:111-20.
11. Reina MA, Collier CB, Prats-Galino A, Puigdellívol-Sánchez A, Machés F, De Andrés JA. Unintentional subdural placement of epidural catheters during attempted epidural anesthesia. Reg Anesth Pain Med. 2011;36:537-41.
12. Reina MA, Pulido DP. El saco dural humano. Origen del espacio subdural espinal. Rev Argentina Anestesiol. 2007;65:167-84.
13. Hogan QH, Mark L. Subdural injection. Reg Anesth Pain Med Internet. 2009;34:10-1.
14. Singh B, Sharma P. Subdural block complicating spinal anesthesia? Anesth Analg. 2002;94:1007-9.
15. Toledano RD, Tsen LC. Epidural catheter design. Anesthesiology. 2014;121:9-17.
16. Tsui BC, Gupta S, Emery D, Finucane B. Detection of subdural placement of epidural catheter using nerve stimulation. Can J Anaesth. 2000;47:471-3.
17. Camorcia M. Testing the epidural catheter. Curr Opin Anaesthesiol. 2009;22:336-40.
18. Galindo Gualdrón LA. Dosis de prueba para anestesia regional. Rev Colomb Anestesiol. 2014;42:47-52.
19. Moore AR, Siddiqui N, Kassel EE, Carvalho JCA. Unintentional subdural catheter placement during labor analgesia shows typical radiological pattern but atypical response to the Tsui test. Int J Obstet Anesth. 2010;19:111-4.
20. Schier R, Guerra D, Aguilar J, Pratt GF, Hernandez M, Boddu K, et al. Epidural space identification: a meta-analysis of complications after air versus liquid as the medium for loss of resistance. Anesth Analg. 2009;109:2012-21.
The Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.) is the owner of all copyrights to any articles published in the journal. Published manuscripts become the permanent property of S.C.A.R.E. and may not be published elsewhere without written permission. S.C.A.R.E. keeps the right to use these manuscripts in any form, including print, video, audio and digital.
Creative Commons License
Open-access articles can be read, downloaded and shared on a free basis upon publication. The Journal publishes all articles under the CCBY- NC-ND license. Attribution-NonCommercial-NoDerivs: CC BY- NC-ND. Of the six main licenses, this is the most restrictive because it only allows others to download and share articles as long as they give credit to the author, but they cannot in any way change the paper or use it commercially.