Kasuistik: Perioperative Schmerztherapie – Fehllage eines thorakalen Periduralkatheters nach Punktion in Seitenlage

Zusammenfassung

Wir berichten über die Fehllage eines thorakalen Periduralkatheters anlässlich einer Trichterbrustkorrektur (minimal-invasive Methode nach NUSS) bei einem 16-jährigen Jungen. Nach problemloser Katheterinsertion und Austestung einer symmetrischen thorakalen Analgesie wurde nach Einleiten der Allgemeinnarkose und Einführen der Endoskopkamera der Periduralkatheter überraschenderweise in der Thoraxhöhle dargestellt werden. Der Katheter wurde daraufhin unter Sicht entfernt und die Operation ohne Zwischenfälle fortgesetzt.

Abstract

(The English abstract contains more information than the German one. The following is a more exact translation of the German text)

We report on a failed epidural puncture for insertion of a catheter during chest wall correction by the minimally invasive procedure according to Nuss in a 16-year-old boy. After insertion of the catheter without any problem and establishment of a symmetrical thoracic analgesia and initiation of general anaesthesia, the catheter was surprisingly observed in the thoracic cavity upon insertion of the endoscopic camera. The catheter was then withdrawn under vision and the operation continued without any further incidents.

Schlüsselwörter:

thorakaler Periduralkatheter - NUSS-OP - intrathorakale Fehllage

Keywords:

thoracic catheter - Nuss procedure - misplaced catheter

Literatur

• 1 Eti Z, Lacin T, Yildizeli B, Dogan V, Gogus FY, Yuksel M. An uncommon complication of thoracic epidural anesthesia: pleural puncture.  Anesth Analg. 2005;  100 1540-1541
• 2 Grieve PP, Whitta RK. Pleural puncture: an unusual complication of a thoracic epidural.  Anaesth Intensive Care. 2004;  32 113-116
• 3 Bush DJ, Kramer DP. Intravascular migration of an epidural catheter during postoperative patient-controlled epidural analgesia.  Anesth Analg. 1993;  76 1150-1151
• 4 Zaugg M, Stoehr S, Weder W, Zollinger A. Accidental pleural puncture by a thoracic epidural catheter.  Anaesthesia. 1998;  53 69-71
• 5 Miura K, Tomiyasu S, Cho S, Sakai T, Sumikawa K. Pneumothorax associated with epidural anesthesia.  J Anesth. 2004;  18 138-140
• 6 Miura K, Tomiyasu S, Cho S, Sakai T, Sumikawa K. Pneumothorax associated with epidural anesthesia.  J Anesth. 2004;  18 138-140
• 7 Cordone MA, Wu CL, Maceda AL, Richman JM. Unrecognized contralateral intrapleural catheter: bilateral blockade may obscure detection of failed epidural catheterization.  Anesth Analg. 2007;  104 735-737
• 8 Lin TC, Huang YS, Lee SC, Ho ST, Cherng CH, Lu CC. Intrapleural misplacement of a thoracic epidural catheter in an anesthetized patient.  Acta Anaesthesiol Taiwan. 2008;  46 49-52
• 9 Shime N, Shigemi K, Hosokawa T, Miyazaki M. Intrathoracic migration of an epidural catheter.  J Anesth. 1991;  5 100-102
• 10 Oku S, Nishimoto N, Danjo S. Epidural catheter accidentally inserted along the left 11th intercostal nerve.  Masui. 1977;  26 190-193
• 11 Nishimoto N, Hibi K, Ueno O. A method for insertion of a catheter by paramedian lumbar epidural puncture (author's transl).  Masui. 1978;  27 628-633
• 12 Iida Y, Kashimoto S, Matsukawa T, Kumazawa T. A hemothorax after thoracic epidural anesthesia.  J Clin Anesth. 1994;  6 505-507
• 13 Inoue S, Nishimine N, Furuya H. Unintentional intrapleural insertion of an epidural catheter: should we remove it or leave it in situ to provide perioperative analgesia?.  Anesth Analg. 2005;  100 266-268