Artigo
Pneumoencéfalo intraventricular após perfuração acidental de dura-máter. Relato de caso
Fecha
2006-10-16Registro en:
Revista Brasileira de Anestesiologia, v. 56, n. 5, p. 511-517, 2006.
0034-7094
1806-907X
10.1590/S0034-70942006000500009
S0034-70942006000500009
2-s2.0-33749574289
2-s2.0-33749574289.pdf
Autor
Centro de Ensino Superior de Maceió
Hospital Escola Doutor José Carneiro
Clínica Santa Juliana
Escola de Ciências Médicas de Alagoas
Hospital Unimed
Hospital da Sagrada Família
Universidade Estadual Paulista (Unesp)
Hospital Regional da Unimed
Hospital do Coração
Hospital Geral de Fortaleza
Resumen
BACKGROUND AND OBJECTIVES: The loss of resistance to air to identify the epidural space is widely used. However, the accidental perforation of the dura mater is one of the possible complications of this procedure, with an estimated incidence between 1% and 2%. The objective of this report was to describe the case of a patient with intraventricular pneumocephalus after the accidental perforation of the dura mater using the loss of resistance with air technique. CASE REPORT: Female patient, 26 years old, 75 kg, 1.67 m, physical status ASA I, with a 38-week pregnancy, was referred to the obstetric service for a cesarean section. Venipuncture was performed after placement of the monitoring. The patient was placed in a sitting position for administration of the epidural anesthesia. During the identification of the epidural space with the loss of resistance with air technique, an accidental perforation of the dura mater was diagnosed by observing free flow of CSF through the needle. The technique was modified to epidural anesthesia and anesthetics were administered by the needle placed in the subarachnoid space. In the first 24 hours, the patient developed headache and she was treated with caffeine, dypirone, hydration, hydrocortisone, and bed rest; despite those measures, the patient's symptoms worsened and evolved to headache in decubitus. A CT scan of the head showed the presence of pneumocephalus. After evaluation by a specialist, the patient remained under observation, with progressive improvement of the symptoms and was discharged from the hospital in the fifth day, without complications. CONCLUSIONS: Pneumocephalus after accidental perforation of the dura mater presented headache with the characteristics of headache secondary to loss of CSF, but with spontaneous resolution after the air was absorbed. Invasive measures, such as epidural blood patch, were not necessary. © Sociedade Brasileira de Anestesiologia, 2006.