Management of a Retained Epidural Catheter in a Pregnant Patient: A Case Report and Review of Literature

Background: Epidural anesthesia is an effective intervention to treat labor pain and provide analgesia for orthopedic procedures. A rare complication of this technique is epidural catheter retention. Case Presentation: In this case report, we present an otherwise healthy 21-year-old G2P0010 woman at 39 weeks and 3 days gestation whose anesthetic management was complicated by a symptomatic retained epidural catheter fragment. Computed tomography (CT) imaging of her spine showed the fractured catheter within her paraspinal muscles and neurosurgery recommended no surgical intervention at that time. The patient reported resolution of back pain while in the postpartum unit which she continues to endorse two weeks after discharge. Conclusion: Retained epidural catheter is a medical emergency that requires immediate imaging and neurological evaluation. While magnetic resonance imaging is typically regarded as the standard imaging modality for this complication, in epidural sets that contain metallic components, we suggest using CT to avoid the risk of thermal nerve damage. In cases where the patient does not report any acute complaints, nonsurgical management may be appropriate but close follow-up is required to monitor for catheter migration.

正常人体输注新鲜和储存的红细胞可引起同等程度的肺气体交换不足的亚临床表现

背景临床上，大多数输血并不一定会g『起并发症，但是输血可导致严重的肺损伤。我们检验了关于输血能}』起轻微的肺功能障碍的假说，此种轻微的肺功能障碍在临床上尚未目』起注意，而且并没有严重到足够符合输血相关急性肺损伤的定义。方法35位健康的志愿者参与本研究，在相隔』周的2个研究日前4周和3周分别抽取JU血液。在研究日，志愿者抽取2u血液，同时随机选择输注其刚抽取的自身新鲜红细胞（redbloodcells，RBCs）或者之前2小时抽取的自身RBCs，以此来维持血容量平衡。随后一周，再次对每个志愿者进行研究，给他们输注不同储存时间的RBCs。在结果中最主要的变量是从输注新鲜或储存RBCs前到输注后卯分钟后肺泡动脉氧分压差（AaDO2）的前后变化。结果输注新鲜和储存了24．5天（P=D．85）的刚90后都会增加AaD02，AaDO2分别增加2．8mmHg（95％可信区间：0．8-4．8；P=0．007）和3．0mmHg（1．4—4．7；P=0．0006）。在储存的去白细胞（1eukoreduced，LR）RBCs中，除了白介素一10（P=0．15），所有测定的细胞因子都比在非去白细胞（non-LR）RBCs中少，然而，相对于输注储存的non-LRRBCs，输注储存的LRRBCs后，血管内皮细胞生长因子是活体内细胞因子测定中唯一增加更多的。血管内皮细胞生长因子是测定的活体内细胞因子中唯一与AaDO，相关的细胞因子。结论根据氧气气体交换功能受损这一证据，输注RBCs可引起轻微的肺功能障碍，这也支持了我们的假说——输血后的肺损伤包括一系列广泛的生理紊乱，且并非必需已存在生理功能异常。这些数据并不支持关于输注储存了21天的RBCs比输注新鲜RBCs损伤更大的假说。