Volume 8, Issue 1, June 2020, Page: 26-29
Acute Myelitis After Correction of Hypospadias with Caudal Anesthesia
Jeniffer Almeida Correa do Nascimento, Department of Anesthesiology, Hospital Federal da Lagoa, Rio de Janeiro, Brazil
Matheus de Castro Abi-Ramia Chimelli, Department of Anesthesiology, Hospital Federal da Lagoa, Rio de Janeiro, Brazil
Jose Eduardo Smilgevicius Silva, Department of Anesthesiology, Hospital Federal da Lagoa, Rio de Janeiro, Brazil
Marcelo Grisolia Gonçalo, Department of Anesthesiology, Hospital Federal da Lagoa, Rio de Janeiro, Brazil
Pedro Paulo Vanzillota, Department of Anesthesiology, Hospital Municipal Jesus, Rio de Janeiro, Brazil
Received: Feb. 14, 2020;       Accepted: Mar. 4, 2020;       Published: Apr. 23, 2020
DOI: 10.11648/j.ijacm.20200801.16      View  281      Downloads  61
Combined epidural anesthesia with general anesthesia is the preferred anesthetic technique for lower limb surgery as well as lower abdominal, genitourinary and perineal surgery in children. This case report below depicts a rare complication: acute myelitis. It occurred following surgical correction of hypospadias (first stage) under combined caudal epidural anesthesia with general anesthesia in an Eight-months-old infant, weighing 9.8 kilograms, with no surgical/anesthetic history, without known allergies, previously healthy, with adequate developmental milestones, physical examination without abnormalities, without difficult airway predictors, with adequate fasting time and normal laboratorial exams. Some etiologies for this case report have been suggested such as spinal cord trauma, infectious and vascular causes, local anesthetic and noxious chemicals neurotoxicity and demyelinating diseases. In spite of thorough scrutiny, we were not able to define a single cause for the clinical manifestations. In this setting, the treatment goal was to provide support measures and rehabilitation of neurological deficits.
Anesthesia, Acute Myelitis, Correction of Hypospadias, Neurological Deficits
To cite this article
Jeniffer Almeida Correa do Nascimento, Matheus de Castro Abi-Ramia Chimelli, Jose Eduardo Smilgevicius Silva, Marcelo Grisolia Gonçalo, Pedro Paulo Vanzillota, Acute Myelitis After Correction of Hypospadias with Caudal Anesthesia, International Journal of Anesthesia and Clinical Medicine. Vol. 8, No. 1, 2020, pp. 26-29. doi: 10.11648/j.ijacm.20200801.16
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This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Suresh, S., Long, J., Birmingham, P. K., & De Oliveira Jr, G. S. (2015). Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database. Anesthesia & Analgesia, 120 (1), 151-156.
Beyaz, S. G., Tokgöz, O., & Tüfek, A. (2011). Caudal epidural block in children and infants: retrospective analysis of 2088 cases. Annals of Saudi medicine, 31 (5), 494-497.
Meyer, M. J., Krane, E. J., Goldschneider, K. R., & Klein, N. J. (2012). Neurological complications associated with epidural analgesia in children: a report of 4 cases of ambiguous etiologies. Anesthesia & Analgesia, 115 (6), 1365-1370.
Jöhr, M. (2015). Regional anaesthesia in neonates, infants and children: an educational review. European Journal of Anaesthesiology (EJA), 32 (5), 289-297.
Chen, Y., Yan, L., Zhang, Y., & Yang, X. (2019). The role of DRP1 in ropivacaine-induced mitochondrial dysfunction and neurotoxicity. Artificial cells, nanomedicine, and biotechnology, 47 (1), 1788-1796.
Desparmet, J. F. (1990). Total spinal anesthesia after caudal anesthesia in an infant. Anesthesia & Analgesia, 70 (6), 665-667.
Muckart, D. J., Bhagwanjee, S., & van der Merwe, R. (1997). Spinal cord injury as a result of endotracheal intubation in patients with undiagnosed cervical spine fractures. Anesthesiology: The Journal of the American Society of Anesthesiologists, 87 (2), 418-420.
Strafford, M. A., Wilder, R. T., & Berde, C. B. (1995). The risk of infection from epidural analgesia in children: a review of 1620 cases. Anesthesia & Analgesia, 80 (2), 234-238.
Martinez-Garcia, E., Pelaez, E., Roman, J. C., & Perez-Gallardo, A. (2005). Transverse myelitis following general and epidural anaesthesia in a paediatric patient. Anaesthesia, 60 (9), 921-923.
Jha S, Kumar R. Transverse myelitis following spinal anesthesia. Neurol India. 2006 Dec; 54 (4): 425-7.
Mukherjee D, Gautam S, Agarwal A, et al. Unexplained episode of sensory-motor deficit following lumbar epidural analgesia. Korean J Pain. 2019 Jan; 32 (1): 53-54.
Gunaydin B, Akcali D, Alkan M. Epidural anaesthesia for Caesarean section in a patient with Devic's Syndrome. Anaesthesia. 2001 Jun; 56 (6): 565-7.
Nishikawa T, Dohi S: Clinical evaluation of clonidine added to lidocaine solution for epidural anesthesia. ANESTHESIOLOGY 1990; 73: 853-9.
J. B. Dahl, L. Simonsen, T. Mogensen, J. H. Henriksen, and H. Kehlet, “The effect of 0.5% ropivacaine on epidural blood flow,” Acta Anaesthesiologica Scandinavica, vol. 34, no. 4, pp. 308–310, 1990.
Sviggum, H. P., Jacob, A. K., Arendt, K. W., Mauermann, M. L., Horlocker, T. T., & Hebl, J. R. (2012). Neurologic complications after chlorhexidine antisepsis for spinal anesthesia. Regional Anesthesia & Pain Medicine, 37 (2), 139-144.
Torsten E. Gordh, Stina Ekman & Anne-Sofie Lagerstedt (1984) Evaluation of Possible Spinal Neurotoxicity of Clonidine, Upsala Journal of Medical Sciences, 89: 3, 266-273.
Killeen, T., Kamat, A., Walsh, D., Parker, A. and Aliashkevich, A. (2012), Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review. Anaesthesia, 67: 1386-1394.
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