1/9. Spontaneous spinal epidural abscess in a neonate. With a review of the literature.Spinal epidural abscess is uncommon in neonates and infants, and is usually related to previous lumbar puncture or epidural anaesthesia. diagnosis is often delayed because of the non-specific presentation. We present a 7-week-old girl who developed paraplegia 3 weeks after transient fever and a self-limiting skin rash. MR imaging revealed an epidural contrast-enhancing lesion compressing the spinal cord. At operation, an organised granulated abscess was identified with staphylococcus aureus the causative organism. laminectomy and removal of the organised abscess and systemic intravenous antibiotics resulted in complete neurological recovery. The patient did not develop late spinal deformity following the decompressive laminectomy. The rapid onset of paraplegia can often be missed in such a young child but should be promptly investigated, as surgical treatment of cord compression carries an excellent prognosis for neurological recovery. We review the literature on the initial presentation, usual investigations, causative organisms and surgical management of paediatric spinal epidural abscesses.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/9. Extradural abscess complicating extradural anaesthesia for caesarean section.Extradural abscess has been described infrequently as a complication of extradural anaesthesia and analgesia. We describe an abscess that developed 5 days after operation in a patient who had extradural anaesthesia for Caesarean section and postoperative analgesia, and review the literature on extradural abscess complicating extradural catheterization, including a discussion on pathogenesis, clinical presentation, diagnosis and management. There have now been 16 reported cases of extradural catheter-related extradural abscess. Only one previous case has been in obstetric practice, despite the widespread use of these techniques in this specialty. A disproportionate number of cases have involved thoracic catheters. Duration of catheterization ranged from 40 h to 6 weeks, the majority of catheters being in place for 5 days or less. The time from catheter placement to development of symptoms ranged from 72 h to 5 months. The causative organism was isolated in 11 cases: staphylococcus aureus was identified in nine (82%) and staphylococcus epidermidis in two (18%). Outcome was reported in 15 cases, of which seven (47%) had a full or near full recovery and eight (53%) had a persistent neurological deficit. One case was managed successfully without surgery. Fifty percent of all cases have been reported in the past 5 years. With the increasing use of extradural techniques for anaesthesia and analgesia, this serious complication may be seen more frequently in the future.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |
3/9. Treatment of acute postoperative endophthalmitis without hospital admission: do we dare?INTRODUCTION: We report the successful management of a culture positive case of APE, without the need for hospital admission and discuss the merits of this strategy. CASE: A 79-year-old lady underwent uncomplicated cataract surgery in her left eye using phacoemulsification under topical and intracameral anaesthesia. She reported to eye casualty four days later, with pain and vision reduced to 6/60 in the left eye. A diagnosis of acute postoperative endophthalmitis was made. A vitreous biopsy was performed and antibiotics injected intravitreally on the same day. The patient was discharged on oral and topical antibiotics on the same day and reviewed subsequently in the clinic as an outpatient. Vision steadily improved and at one month following intravitreal injection her vision had improved to 6/9 unaided. The cornea remained clear, with a quiet anterior chamber and a clear view of the fundus. DISCUSSION: Current management of acute postoperative endophthalmitis in the UK includes a vitreous biopsy, administration of antibiotics into the vitreous cavity, admission of patients to a hospital ward and daily review. It is our opinion that under the circumstances where patients are fit and well, without significant co-morbidity, hospital admission is not necessary as demonstrated by the patient in our report.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/9. Delayed presentation of an extradural abscess complicating thoracic extradural analgesia.Extradural abscess is a rare but recognized complication of extradural anaesthesia. Previous reports have been associated with a short time interval between extradural catheterization and presentation. We report a patient with rheumatoid arthritis, receiving steroid therapy, in whom an extradural abscess did not present until 23 days after the insertion of a thoracic extradural catheter to provide postoperative analgesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/9. epidural abscess: a hazard of spinal epidural anaesthesia.Two cases of spinal epidural abscess following prolonged epidural anaesthesia are presented. The clinical features included fever, malaise, and signs of nerve root compression; backache was not marked. Prompt surgical drainage and appropriate antibiotics are required to avoid the costly sequelae of bladder and leg paralysis from spinal cord compression. Both infections were caused by bacterial contamination of catheter, and although this complication is uncommon, it emphasizes that strict asepsis is essential during continuous epidural anaesthesia.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
6/9. Sacro-iliitis in a heroin addict. A contra-indication to spinal anaesthesia.A case is presented of a pregnant heroin addict patient, with a septic sacro-iliitis due to staphylococcus aureus. The incidence of joint infections in heroin addicts and the difficulty of diagnosis is discussed with the potential risks of spinal or extradural anaesthesia when there is infection in joints close to the needle site. Caution is advised with patients addicted to heroin who have low back pain and may have infectious sacro-iliitis.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
7/9. Infected false aneurysm after puncture of an aneurysm of the deep femoral artery.Pseudoaneurysm of the femoral artery is a well known complication after diagnostic and therapeutic catheterisation. We report a case of voluminous postcatheterisation false aneurysm, which developed on a pre-existing deep femoral artery aneurysm. infection by staphylococcus aureus was demonstrated. After surgical exploration, rupture and external haemorrhage occurred before reconstructive surgery was possible. Due to the septic conditions only a lateral aneurysmorraphy was performed. Postoperative angiogram showed an acceptable result. An aneurysm of the deep femoral artery was also demonstrated on the contralateral side. This was scheduled for elective surgery. In conclusion, this complication could have been avoided by accurate puncture technique. Surgical exploration under local anaesthesia is ill-advised. Especially in patients with advanced vascular disease, non-invasive studies of the puncture site is recommended.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
8/9. Conservative management of extradural abscess complicating spinal-extradural anaesthesia for caesarean section.We report a case of lumbar extradural abscess that presented 9 days after an elective Caesarean section performed under combined spinal-extradural anaesthesia. This was successfully treated conservatively with full recovery. The clinical course included development, and then resolution, of mild paraparesis. Conservative treatment of an extradural abscess in the obstetric population has not been described previously.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
9/9. Spinal epidural abscess.AIMS: To review the clinical presentation and outcome of patients with spinal epidural abscess. methods: Following an index case, additional cases were identified during 1991-6. RESULTS: There were a total of seven patients with spinal epidural abscess and an average age of 52 years (range 24-75 years). The abscess locations were cervical (3), thoracic (3) or thoracolumbar (1), and extended on average 4.3 vertebral bodies (range 2-9). staphylococcus aureus was the aetiologic agent in all of the six microbiologically confirmed cases. Three abscesses arose from adjacent vertebral osteomyelitis, one followed epidural anaesthesia and two arose by haematogenous spread. New spinal or radicular pain were the most frequent early symptoms, later, nerve root weakness or a sensory level. An ESR > 30 mm/hour was consistently present but fever and leukocytosis were absent in some patients. MRI (five cases) and myelography (one case) were diagnostic. Five patients underwent laminectomy and abscess drainage; in three, limb weakness improved markedly post operatively. Three of the four patients with paralysis died, two despite laminectomy. CONCLUSIONS: New spinal pain, radicular symptoms or signs, and a raised ESR were the most consistent early abnormalities in patients with a spinal epidural abscess. diagnosis at an early clinical stage was associated with a better outcome.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |