Anesth Pain Med.  2024 Apr;19(2):150-155. 10.17085/apm.23105.

Unintended subdural anesthesia and subdural air bubbles after attempted epidural anesthesia in a patient undergoing cesarean section

• Kim JE
• Lee J
• Lee G
• Chung MH
• Choi YR
• Choi EM

• KMID: 2555252
• DOI: http://doi.org/10.17085/apm.23105

Abstract

Unintended subdural anesthesia accompanied by air bubbles compressing the cauda after attempting epidural anesthesia is rare. A 41-year-old pregnant woman was scheduled to undergo epidural anesthesia for cesarean section. After attempting epidural anesthesia, she experienced prolonged hypotension and recovery time, especially in the right extremity. Through magnetic resonance imaging (MRI) we found subdural air bubbles compressing the right side of the cauda equina in the L3 region. Thus, we considered unintended subdural anesthesia and performed conservative management with close observation. Her symptoms completely resolved within 24 h. Here, we report a case with various features of subdural anesthesia and subdural air bubbles compressing the cauda.

Keyword

Anesthesia; Cauda equina; Cesarean section; Epidural; Female; Magnetic resonance imaging

Figure

• 

  Fig. 1. T1-weighted magnetic resonance imaging (A, B) shows a low signal intensity measuring approximately 2.8 × 0.4 cm accompanied by left deviation of the cauda equine in the L3 region. On T2-weighted MRI (C, D), multiple low-signal-intensity dots were observed in the anterior aspect of the spinal cord (indicated by arrows), suggesting the presence of air bubbles in the L3 region.

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  Fig. 2. In the T2-weighted magnetic resonance imaging (MRI) (A, B), the interval follow-up shows improvement in the presence of air bubbles and left deviation of the cauda equine in the L3 region.

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