Spinal Epidural Hematoma during Anticoagulant Therapy for Pulmonary Embolism: Postoperative Complications in a Patient with Lung Cancer
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- Kobayashi Yoshihisa
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
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- Nakada Junya
- Department of Anesthesiology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
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- Kuroda Hiroaki
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
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- Sakakura Noriaki
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
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- Usami Noriyasu
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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- Sakao Yukinori
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
抄録
Spinal epidural hematoma (SEH) is rare but causes neurological disorders. Rapid diagnosis and treatment maximize neurological recovery. We present the case of SEH after lung cancer surgery under epidural and general anesthesia. A 64-year-old man underwent right upper lobectomy. Pulmonary embolism occurred on postoperative day 2. Anticoagulant therapy with fondaparinux and warfarin was started 2 hours after epidural catheter removal and he gradually recovered. On postoperative day 13, the level of prothrombin time-international normalized ratio reached 1.47 and fondaparinux administration was stopped. The next day, he developed back pain and paraplegia, and magnetic resonance imaging revealed a mass between Th4 and Th7 compressing the spinal cord. Emergency decompression laminectomy and hematoma evacuation were performed. After 2.5 months of rehabilitation, he regained almost all motor function and sensation. Late after epidural anesthesia, attention should be paid to possible SEH even though appropriate anticoagulant therapy had been initiated after epidural catheter removal.
収録刊行物
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- Annals of Thoracic and Cardiovascular Surgery
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Annals of Thoracic and Cardiovascular Surgery 20 (Supplement), 493-496, 2014
Annals of Thoracic and Cardiovascular Surgery 編集委員会