Kateter Epidural Terputus Saat Dipasang

Latar belakang: Anestesia epidural adalah satu bentuk dari anestesia regional dan merupakan salah satu bentuk teknik blok neuroaksial, dimana penggunaannya lebih luas daripada anesthesia spinal. Teknik epidural sangat luas penggunaanya pada anestesia operatif, analgesia untuk kasus obstetri, analgesia post operatif dan untuk nyeri kronis. Morbiditas dan bahkan mortalitas pascaoperasi dapat dikurangi ketika blokade neuraksial digunakan, baik sebagai agen tunggal maupun sebagai kombinasi dengan anestesi umum.
Kasus: Seorang wanita usia 45th, ASA II dengan Adenokarsinoma Lambung yang akan menjalani operasi Gastrektomi Parsial. Penilaian preoperasi pasien sudah dalam kondisi yang optimal. Direncanakan akan dilakukan anestesi dengan teknik Epidural, insersi pada ruang intervertebra lumbal 3-4 dengan pemasangan kateter epidural tetapi gagal dipasang dan terputus 1cm saat pencabutan. Kemudian teknik anestesi dikonversi menjadi anestesi umum.
Pembahasan: Kerusakan kateter adalah komplikasi yang dapat dikenali pada anestesi epidural, sering dikaitkan dengan trauma pada penusukan jarum epidural atau kekuatan yang berlebihan saat penarikan kateter. Pemeriksaan CT scan lebih sensitif daripada MRI dalam mendeteksi fragmen kateter dalam ruang epidural dan lebih sensitif dengan radiografi polos, terutama untuk fragmen kecil. Pengelolaan post operasi, potongan kateter epidural yang dianggap benda asing umumnya dianggap sebagai tidak aktif dan seharusnya tidak menghasilkan reaksi tubuh.
Kesimpulan: Meskipun dikatakan potongan kateter epidural yang dianggap benda asing umumnya tidak menghasilkan reaksi tubuh. Pada kebanyakan kasus, standard penanganan terputusnya segmen kateter epidural, adalah dengan membiarkan dengan pengawasan sampai muncul gejala simptomatik. Namun, ada situasi di mana operasi pengangkatan harus dilakukan.
Article Metrics:
- Morgan GE, Mikhail MS. Clinical Anesthesiology, 5th Edition. Philadelphia. Lange Medical Books/ McGraw-Hill Education; 2013, p 1019 – 21
- Brown L, David. MD. Atlas of Regional Anesthesia. 4th edition. United state: Elsevier; 2010, 250– 3
- Mitra R, Fleischmann K. Management of the sheared epidural catheter : is surgical extraction really necessary? Journal of Clinical Anesthesia. 2007; 19:310–4
- Pant D, Jain P, Kanthed P, Sood J. Epidural catheter breakage: a dilemma. Indian J Anaesth. 2007;51:434
- Staats PS,Stinson MS,Lee R.Lumbar stenosis complicating retained epidural catheter tip.Anesthesiology. 1995;83:1115-18
- DeArmendi A,Ryan J,Chang H, et al. Retained caudal catheter in a paediatric patient. Paed Anaes. 1992; 2:325-27
- Jongleux EF,Miller R,Freeman A. An entrapped epidural catheter in a postpartum patient.Reg Anesth Pain Med. 1998;23:615-17
- Collier C. Epidural catheter break- age: a possible mechanism. Int J Obstet Anesth.2000;9:87–93. http://dx.doi.org/10.1054/ijoa.1999.0354. [PubMed]
- Gülcü N. The diagnosis and treat- ment in epidural catheter break- ages. Uludağ University Medical Journal. 2007;33:29–32
- Lee YH, Hwang HY, Sim WS, Yang M, Lee CJ. Breakage of a thoracic epidural catheter during its removal -A case report- Korean J Anesthesiol. 2010;58:569–72.http:// dx.doi.org/10.4097/ kjae.2010.58.6.569. [PMC free arti- cle] [PubMed]
- Lenox WC, Kost-Byerly S, Shipley R, Yaster M. Pediatric caudal epidural catheter sequestration: an unusual complication. Anesthesiology. 1995;83:1112–4
- Nishio I, Sekiguchi M, Aoyama Y, Asano S, Ono A. Decreased tensile strength of an epidural catheter during its removal by grasping with a hemostat. Anesth Analg. 2001;93:210–2
- Schummer W, Schummer C. Another cause of epidural catheter breakage? Anesth Analg. 2002;94:233. http://dx.doi.org/10.1213/00000539-200201000-00047
- Mitra R, Fleischmann K. Management of the sheared epidural catheter: is surgical extraction really necessary? J Clin Anesth. 2007;19:310–4
- Pant D, Jain P, Kanthed P, Sood J. Epidural catheter breakage: A dilemma. Indian J Anaesth. 2007;51:434–7
- Lee YH, Hwang HY, Sim WS, Yang M, Lee CJ. Breakage of a thoracic epidural catheter during its removal – A case report. Korean J Anesthesiol. 2010;58:569–72
- Mitra R, Fleischmann K. Management of the sheared epidural catheter: Is surgical extraction really necessary? J Clin Anesth. 2007;19:310–4
- Coombs DW,Franklin JD,Meier FA,et al.Neuropathologic lesions and CSF morphine during chronic continuous intraspinal morphine infusion: a clinical & post mortem study.Pain 1985;22:337-51
- Sidhu MS,Asrani RV,Bassell GM. An unusual complication of extradural catheterization in obstetric anaesthesia. Br J Anaesth 1983; 55:473-75
- Pasquariello C,Betz R. A case for the removal of the retained intrathecal catheter. Anesth Analg 1991;72:562
- Ugboma S, Au – Truong X, Kranzler LI, et al. The breaking of an intrathecally placed epidural catheter during extraction. Anesth Analg 2002; 95: 1087 – 9
- Gough JD, Johnston KR, Harmer M. Kinking of epidural catheters. Anesthesia. 1989;40:1060
- shikawa Y, Magma S, Ito Z, et al. Delayed onset of subdural hematoma following epidural catheter breakage. Global spine J. 2016;6(1):e1-6
- Vallejo MC, Adler LJ, Finegold H, Mandell GL, Ramanathan S. Peri- osteal entrapment of an epidural catheter in the intrathecal space. Anesth Analg. 2001;92:1532–4. http://dx.doi.org/10.1097/00000539- 200106000-00036. [PubMed]
- Mitra, R, Fleischmann, K. Management of the sheared epidural catheter: is surgical extraction really necessary? Journal of Clinical Anesthesia 2007; 19: 310–4
Last update: 2021-04-17 18:25:45
Last update: 2021-04-17 18:25:45
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