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Spinal epidural hematoma after epidural anesthesia in a patient receiving enoxaparin -A case report-.

Han IS, Chung EY, Hahn YJ - Korean J Anesthesiol (2010)

Bottom Line: Spinal epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia.Enoxaparin sodium is a low molecular weight heparin (LMWH) for use in preventing deep venous thrombosis in patients undergoing total hip arthroplasty and total knee arthroplasty.Hemorrhage is an uncommon but documented adverse reaction when using LMWH.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

ABSTRACT
Spinal epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia. Enoxaparin sodium is a low molecular weight heparin (LMWH) for use in preventing deep venous thrombosis in patients undergoing total hip arthroplasty and total knee arthroplasty. Hemorrhage is an uncommon but documented adverse reaction when using LMWH. We report a case of epidural hematoma after lumbar epidural anesthesia in a patient who administered enoxaparin in perioperative period.

No MeSH data available.


Related in: MedlinePlus

Spine sagital magnetic resonance image showing the epidural hematoma (arrows) in the posterior epidural space along T8-L5 with resultant compression of the spinal cord and thecal sac.
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Figure 1: Spine sagital magnetic resonance image showing the epidural hematoma (arrows) in the posterior epidural space along T8-L5 with resultant compression of the spinal cord and thecal sac.

Mentions: The patient recovered uneventfully from the epidural anesthetic. That evening, enoxaparin 40 mg administered subcutaneously. The second dose time of the enoxaparin (LMWH) was 2 hours after the removal of the epidural catheter. On the evening of the second postoperative day, 4 hours after the fourth enoxaparin administration, the patient complained reduced sensation of the right, nonoperated leg as well as motor weakness of the left leg. No back pain was reported. Emergency magnetic resonance imaging revealed T8-L5 epidural hematoma with cord compression (Fig. 1). Emergency decompressive laminectomy to evacuate the hematoma was performed. There was a delay of 5 hours after the neurosurgical decision because of family's refusal. No vascular malformation was seen. Before the second surgical procedure, coagulation profile was showed as hemoglobin 6.4 g/dl, Hct 18.9%, prothrombin time 49.8%, activated partial thromboplastin time 63.1 seconds, international normalized ratio 1.49, fibrinogen 71 mg/dl (normal range, 80-415), antithrombin III 54% (normal range, 60-90%), D-dimer 461 ng/ml (normal range, 0-322), and a platelet count of 129,000/mm3. Postoperatively there was no improvement in neurologic function. Twelve packed red blood cells and 5 fresh frozen plasmas were used from the initial operation to the second operation. The patient subsequently expired from myocardial infarction attack 2 days later.


Spinal epidural hematoma after epidural anesthesia in a patient receiving enoxaparin -A case report-.

Han IS, Chung EY, Hahn YJ - Korean J Anesthesiol (2010)

Spine sagital magnetic resonance image showing the epidural hematoma (arrows) in the posterior epidural space along T8-L5 with resultant compression of the spinal cord and thecal sac.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2926428&req=5

Figure 1: Spine sagital magnetic resonance image showing the epidural hematoma (arrows) in the posterior epidural space along T8-L5 with resultant compression of the spinal cord and thecal sac.
Mentions: The patient recovered uneventfully from the epidural anesthetic. That evening, enoxaparin 40 mg administered subcutaneously. The second dose time of the enoxaparin (LMWH) was 2 hours after the removal of the epidural catheter. On the evening of the second postoperative day, 4 hours after the fourth enoxaparin administration, the patient complained reduced sensation of the right, nonoperated leg as well as motor weakness of the left leg. No back pain was reported. Emergency magnetic resonance imaging revealed T8-L5 epidural hematoma with cord compression (Fig. 1). Emergency decompressive laminectomy to evacuate the hematoma was performed. There was a delay of 5 hours after the neurosurgical decision because of family's refusal. No vascular malformation was seen. Before the second surgical procedure, coagulation profile was showed as hemoglobin 6.4 g/dl, Hct 18.9%, prothrombin time 49.8%, activated partial thromboplastin time 63.1 seconds, international normalized ratio 1.49, fibrinogen 71 mg/dl (normal range, 80-415), antithrombin III 54% (normal range, 60-90%), D-dimer 461 ng/ml (normal range, 0-322), and a platelet count of 129,000/mm3. Postoperatively there was no improvement in neurologic function. Twelve packed red blood cells and 5 fresh frozen plasmas were used from the initial operation to the second operation. The patient subsequently expired from myocardial infarction attack 2 days later.

Bottom Line: Spinal epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia.Enoxaparin sodium is a low molecular weight heparin (LMWH) for use in preventing deep venous thrombosis in patients undergoing total hip arthroplasty and total knee arthroplasty.Hemorrhage is an uncommon but documented adverse reaction when using LMWH.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

ABSTRACT
Spinal epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia. Enoxaparin sodium is a low molecular weight heparin (LMWH) for use in preventing deep venous thrombosis in patients undergoing total hip arthroplasty and total knee arthroplasty. Hemorrhage is an uncommon but documented adverse reaction when using LMWH. We report a case of epidural hematoma after lumbar epidural anesthesia in a patient who administered enoxaparin in perioperative period.

No MeSH data available.


Related in: MedlinePlus