術後肺塞栓の治療時に硬膜外カテーテルを抜去した後に発生した脊椎硬膜外血腫

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  • Epidural Hematoma Associated with Heparin Therapy for Postoperative Pulmonary Embolism.

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The patient was a 52-year-old man with an ASA physical status I, receiving general anesthesia combined with epidural anesthesia for removal of an abdominal tumor, developed pulmonary embolism in the postoperative period. Heparin was given intravenously and an epidural catheter was removed at the request of the surgeon. The patient complained of severe back pain and developed paraplegia about 5 hr after initiation of the heparin therapy. The heparin infusion was discontinued and a MRI was performed, which revealed an epidural hematoma extending from T12-L1. Four hours later, a laminectomy was performed to remove the epidural hematoma, but postoperatively there was no improvement in neurological function over the next several months. Although such complication is rare, it is likely to occur in the patient with an epidural catheter during heparin therapy for postoperative pulmonary embolism. We suggest that an epidural catheter should not be removed during heparin therapy.

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