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當硬脊髓膜管子不好拔時怎麼辦
Journal Volume
中山醫學雜誌 v14 n.1 p151-158
Date Issued
2010-07-28T08:56:59Z
Abstract
拔出硬脊髓膜外管不是一件困難的事，可在很短的時間完成。我們報告一位30歲男子，因肛門瘺管接受清瘡、瘺管切除、皮瓣切除。使用硬脊髓外麻醉，在第4第5腰椎間，插入6公分的管子進入硬脊膜外腔。整個過程進行順利，無導管送行困難或麻痺、觸電的感覺。手術順利完成後，在恢復室時，要拔除導管卻遇到很大的阻力，經過30分鐘的努力，很幸運的是，導管終於被移除，沒有斷裂、打結或折痕，只是導管被拉扯的很長。本報告主要是提醒麻醉同道有許多方法可拔除硬膜外導管。
Removing an epidural catheter is usually not difficult and can be finished within minutes. However, we report difficulties encountered in a patient who underwent lumbar epidural anesthesia using an 18 gauge Portex multi-hole catheter via the L4-5 interspace. The catheter was threaded 6 cm into the epidural space without difficulty. No paresthesias occurred during the procedure. After a 1 hour 15 minute operation, patient was sent to the post anesthetic care unit. Considerable resistance was encountered when we attempted to remove the epidural catheter. After 30 minutes of effort, the stretched catheter was retrieved. No kinks, knots, or breaks were present. Our report is intended to inform colleagues regarding different methods for removing epidural catheters when resistance is encountered.
Removing an epidural catheter is usually not difficult and can be finished within minutes. However, we report difficulties encountered in a patient who underwent lumbar epidural anesthesia using an 18 gauge Portex multi-hole catheter via the L4-5 interspace. The catheter was threaded 6 cm into the epidural space without difficulty. No paresthesias occurred during the procedure. After a 1 hour 15 minute operation, patient was sent to the post anesthetic care unit. Considerable resistance was encountered when we attempted to remove the epidural catheter. After 30 minutes of effort, the stretched catheter was retrieved. No kinks, knots, or breaks were present. Our report is intended to inform colleagues regarding different methods for removing epidural catheters when resistance is encountered.