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Airway complication due to retropharyngeal spread of epidural abscess during prone position.

Choudhuri AH, Kumar M - J Anaesthesiol Clin Pharmacol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, GB Pant Hospital, New Delhi, India.

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Sir, A 17-year-old male, weighing 55 kg presented with a history of seizures associated with paraparesis, patchy sensory loss in the limbs and urinary incontinence... There was no restriction in neck mobility and mouth opening... Systemic examination did not reveal any other abnormality... Finally, the patient was turned supine and re-examined... The airway pressures gradually reduced and reached the baseline value... The alar fascia (also known as prevertebral fascia) is the posterior border of the retropharyngeal space, which reaches the D2 vertebra caudally... Since our patient had a multiple epidural abscesses including a large abscess at the level of D2 vertebra, the cause of the increased airway pressure could be explained by anterior extension of the abscess... Although retropharyngeal abscesses are known to cause airway compromise, this is possibly a rare instance that retrophayngeal spread of an epidural abscess caused airway complication in the prone position after induction of anesthesia... In all the instances, vertebral abscesses extended into the retropharynx, mediastinum and posterior triangles along the epidural space... The increase in PIP during anesthesia can occur due to underlying inflammation associated with conditions such as bronchial asthma, chronic obstructive airway disease, respiratory tract infection, laryngoscopy, ETT malpositioning, presence of endobronchial foreign body or growth, anaphylaxis etc... Most of these conditions can be managed barring a few exceptions like this... The presence of multiple cervical abscesses (vertebral or epidural) during pre-operative examination should prompt the anesthesiologist to anticipate high risk of such complication and devise a prior strategy in consultation with the surgeons to avoid any serious mishap.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance imaging showing the extent of epidural abscess
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Figure 1: Magnetic resonance imaging showing the extent of epidural abscess

Mentions: A 17-year-old male, weighing 55 kg presented with a history of seizures associated with paraparesis, patchy sensory loss in the limbs and urinary incontinence. On evaluation, he was diagnosed having tuberculoma in occipital region with cervical lymphadenitis and multiple cold abscesses in the neck. The magnetic resonance imaging showed lytic lesions involving C7, D2 and D7-D10 vertebral bodies with large pre- and paravertebral abscess. There was an evidence of cord compression by paravertebral abscess extending into epidural space in D7-D9 levels [Figure 1]. Patient was prescribed anti-tubercular treatment since the past 2 months. The surgical plan was to decompress the spinal cord by evacuating the pus and to do a surgical biopsy to exclude lymphoma.


Airway complication due to retropharyngeal spread of epidural abscess during prone position.

Choudhuri AH, Kumar M - J Anaesthesiol Clin Pharmacol (2014)

Magnetic resonance imaging showing the extent of epidural abscess
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927272&req=5

Figure 1: Magnetic resonance imaging showing the extent of epidural abscess
Mentions: A 17-year-old male, weighing 55 kg presented with a history of seizures associated with paraparesis, patchy sensory loss in the limbs and urinary incontinence. On evaluation, he was diagnosed having tuberculoma in occipital region with cervical lymphadenitis and multiple cold abscesses in the neck. The magnetic resonance imaging showed lytic lesions involving C7, D2 and D7-D10 vertebral bodies with large pre- and paravertebral abscess. There was an evidence of cord compression by paravertebral abscess extending into epidural space in D7-D9 levels [Figure 1]. Patient was prescribed anti-tubercular treatment since the past 2 months. The surgical plan was to decompress the spinal cord by evacuating the pus and to do a surgical biopsy to exclude lymphoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, GB Pant Hospital, New Delhi, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, A 17-year-old male, weighing 55 kg presented with a history of seizures associated with paraparesis, patchy sensory loss in the limbs and urinary incontinence... There was no restriction in neck mobility and mouth opening... Systemic examination did not reveal any other abnormality... Finally, the patient was turned supine and re-examined... The airway pressures gradually reduced and reached the baseline value... The alar fascia (also known as prevertebral fascia) is the posterior border of the retropharyngeal space, which reaches the D2 vertebra caudally... Since our patient had a multiple epidural abscesses including a large abscess at the level of D2 vertebra, the cause of the increased airway pressure could be explained by anterior extension of the abscess... Although retropharyngeal abscesses are known to cause airway compromise, this is possibly a rare instance that retrophayngeal spread of an epidural abscess caused airway complication in the prone position after induction of anesthesia... In all the instances, vertebral abscesses extended into the retropharynx, mediastinum and posterior triangles along the epidural space... The increase in PIP during anesthesia can occur due to underlying inflammation associated with conditions such as bronchial asthma, chronic obstructive airway disease, respiratory tract infection, laryngoscopy, ETT malpositioning, presence of endobronchial foreign body or growth, anaphylaxis etc... Most of these conditions can be managed barring a few exceptions like this... The presence of multiple cervical abscesses (vertebral or epidural) during pre-operative examination should prompt the anesthesiologist to anticipate high risk of such complication and devise a prior strategy in consultation with the surgeons to avoid any serious mishap.

No MeSH data available.


Related in: MedlinePlus