A response to ‘Emergency cricothyrotomy: a randomised crossover trial comparing the wire‐guided and catheter‐over‐needle techniques’, Fikkers BG, van Vugt S, van der Hoeven JG, van den Hoogen FJA, Marres HAM, Anaesthesia 2004; 59: 1008–11
A response to ‘Emergency cricothyrotomy: a randomised crossover trial comparing the wire‐guided and catheter‐over‐needle techniques’, Fikkers BG, van Vugt S, van der Hoeven JG, van den Hoogen FJA, Marres HAM, Anaesthesia 2004; 59: 1008–11
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对“紧急环甲膜切开术：比较线引导和导管针技术的随机交叉试验”的回应，Fikkers BG、van Vugt S、van der Hoeven JG、van den Hoogen FJA、Marres HAM，麻醉 59； 1008–11
作者：
R. Hodgson
关于哈登医生的病例，我们希望报告最初归因于硬膜外血肿的转化反应。一名 33 岁的女士接受了剖腹手术，以改善右侧肾积水，该积水被认为是由于之前手术留下的疤痕组织造成的。手术前安全地进行了清醒的硬膜外麻醉，手术后继续输注低剂量布比卡因/二吗啡。术前未给予肝素。第二天早上，患者主诉左腿明显无力。经过检查，她的左腿似乎完全运动无力，而右腿运动正常。最初，人们认为已经形成了硬膜下阻滞[1]。停止输注并移除导管。几个小时后，弱点仍然存在。我们担心硬膜外血肿已发生，因此她被紧急转诊至三级中心进行神经外科检查。脊柱 MRI 报告显示正常。神经系统检查显示左腿完全单瘫，仅有间歇性肌肉收缩。她的反射正常，胡佛征呈强阳性（无自愿髋部伸展，但在测试另一条腿的髋部屈曲时髋部伸展正常）。她被诊断为功能性瘫痪，强烈保证她会随着时间的推移而康复，并出院回到我们医院。从那时起，情况逐渐好转。我们知道脊髓麻醉后报告了类似的病例[2]。我们同意哈登博士的观点，即当面临不寻常的神经系统症状发作时，应考虑诊断，但只有在排除潜在的灾难性其他原因后才应考虑。
Furthur to Dr Haden’s case, we wish to report a conversion reaction that was initially attributed to an epidural haematoma. A 33-year-old lady underwent a laparotomy to improve a right hydronephrosis thought to be due to scar tissue from previous surgery. An awake, pre-operative epidural was placed uneventfully and a low dose bupivacaine ⁄ diamorphine infusion was continued following surgery. No pre-operative heparin had been given. The following morning, the patient complained of marked weakness in her left leg. On examination there appeared to be complete motor weakness to her left leg with normal movement of the right leg. Initially, it was thought that a subdural block had developed [1]. The infusion was stopped and the catheter removed. Some hours later, the weakness was still present. We were concerned that an epidural haematoma had developed and so she was referred urgently to a tertiary centre for neurosurgical review. An MRI of the spine was reported as normal. Neurological examination described a complete monoplegia of the left leg with only intermittent muscle contractions. She had normal reflexes and a strongly positive Hoover sign (no voluntary hip extension but normal hip extension when testing hip flexion in the other leg). She was diagnosed as having a functional paralysis, strongly reassured that there should be recovery over time and discharged back to our hospital. Since then, there has been gradual improvement. We are aware of a similar case being reported following spinal anaesthesia [2]. We agree with Dr Haden that the diagnosis should be considered when faced with the unusual onset of neurological symptoms but only after exclusion of potentially catastrophic other causes.