半麻也有风险，竟然这么严重( 二 )

??有无服用抗凝药病史，如支架术后服用氯吡格雷，阿司匹林等；
??有无服用影响凝血的保健品如银杏口服液等；
??术前有无胸腰椎外伤手术畸形病史；
??有无硬膜外麻醉或腰麻病史，特别是异常病史；
??术前完善出凝血功能检查及脊柱的CT、MRI检查等；
??完善神经功能检查。
??术中：操作的规范性
??定位、穿刺、判断、置管按操作规范操作，
??注意动作的轻柔性，切忌暴力，
??回抽有血性液体需要退回重新寻找进路，
??穿刺时有神经刺激异感时也需要调整
??每次注药都需要回抽验证。
??术后：加强随访
??术后加强随访和相关检查
??早期和反复的神经系统检查
??快速调查任何轻微的神经功能缺损。
Continuous epidural catheter for anaesthesia management and post-op pain relief in colorectal surgery, complicated by epidural haematoma and bilateral paraplegia: A case report
Introduction: Utilising epidural analgesia (EA) during major abdominal surgery in combination with general anaesthetic, is a proven approach to decrease anaesthetic requirement in patients with severe comorbidities, enhance recovery and improve pain management.
Case presentation: Herein we report a case of an 81-years-old female with bilateral lower limb sensory loss, saddle paraesthesia, paraplegia, and incontinence following a thoracic epidural catheterisation required for low anterior resection of rectal adenocarcinoma. The complication was reported by the patient on the third day of post-op.
Clinical discussion: The magnetic resonance imaging results revealed an extradural extramedullary hyperintense haematoma in the spinal cord at T12-L2 vertebral level. The neurological deficit was addressed urgently with laminectomy; and following implementation of intensive inpatient physiotherapy and rehabilitation regiment the patient restored mild motor function.
Conclusion: We believe the culprit of the acute focal neurology deficits in this patient could be due to the epidural catheterisation and the post-op local anaesthetic injections. From this case, we anecdotally recommend performing thoracolumbar MRI as part of pre-op workup in patients with long standing back issues or claudication, considering x-ray guided catheterisation in higher risk patients for epidural hematoma, and early and repeated neurological examination and rapid investigation for any mild neurological deficits.
Keywords: Colorectal cancer surgery; Continuous epidural analgesia; Epidural anaesthesia; Epidural haematoma; Paraplegia post-op; Surgical case report.