30 years old lady . Elective Caesarean Section for primigravida with breech presentation.
Planned for spinal anesthesia .
Quinke 27G spinal needle inserted from paramedian approach , at L 23 level , while patient is lying on right lateral position.
During insertion , there was no difficulty , needle advanced until " give " sensation was felt . Clear CerebroSpinal Fluid was seen. While waiting for the CSF flow to reach the hub of the needle , the patient had a sudden jerky movement . The CSF stopped flowing , the anesthesiologist tried to pull out the needle a little , hoping that the CSF will flow again , but did not see any fluid coming out. So she decided to pull out the needle & reinsert , but when the needle was being pull out , only 3/4 of the length was pulled out. Apparently the needle had broken inside the patient.
What will you do next?作者: 魏铁钢 时间: 2010-3-8 22:33
英文不是 太好,不过勉强看明白.
主要是制动的问题,我做麻醉的时候一定会跟患者说明白,不要动,而且还找个有个护士在患者前面把着.
说实在的置入腰麻针的时候真怕刺激到神经导致患者掉地下,作者: shenxiu2 时间: 2010-3-10 20:36
The problem was explained to the patient & her husband. The patient was then put under general anesthesia , caesarean section was done to delivered her baby .
After the caesarean section , she was then referred to the neurosurgeon . Localization of the broken spinal needle was done using the portable X ray machine ( Image Intensifier) , she was then positioned prone , and the neurosurgeon opened up the back ( about 5 cm incision ) where the location of the needle was identified & marked. The needle was retrieved . And the wound closed. The localization took about 20 minutes, and the surgery to remove the needle took another 20 minutes. The needle was outside of the spinal space .
The patient was then reversed & woken up . She was observed for signs of spinal irritation and neurological deficit.
The recovery was uneventful.
This is the first time I have seen such a case like this .
We had sent the broken spinal needle to the company that supplied the needle & asked them to make a study as to whether it was due to the defect of the needle that had caused the breaking .
As this is a potential medicolegal case , so all documentations were done carefully in details.作者: loong 时间: 2011-9-9 23:08
The needle was outside of the spinal space .作者: jli 时间: 2011-11-15 05:43
Thanks for sharing. A rare but interesting case.
- overseas Anaesthetist作者: 好麻师不好当 时间: 2013-7-16 23:04
Apparently the needle had broken inside the patient.What will you do next?