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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Extensive extradural pneumorrhachis related to obstetric analgesia
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Vol. 71. Issue 6.
Pages 491-495 (June - July 2024)
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Vol. 71. Issue 6.
Pages 491-495 (June - July 2024)
Case report
Extensive extradural pneumorrhachis related to obstetric analgesia
Neumorraquis extradural extenso relacionado con analgesia obstétrica
M.J. Garcia-Cebriána, I.M. Fontan-Atalayab, J. Garcia-Pereza, B. Fernandez-Torresa,c,
Corresponding author
bartolome@us.es

Corresponding author.
a Servicio de Anestesiología y Reanimación, Hospital Virgen Macarena, Seville, Spain
b Servicio de Obstetricia y Ginecología, Hospital Virgen Macarena, Seville, Spain
c Departamento de Cirugía, Facultad de Medicina, Universidad de Seville, Spain
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Abstract

Iatrogenic extradural pneumorrhachis is a rare clinical entity, but anesthesiologists should be aware of this possibility when using the air technique for the identification of epidural space. Although in most published cases extradural pneumorrhachis is asymptomatic, relevant neurological consequences have been described, such as meningeal irritation, radicular pain, unilateral lower extremity weakness, cauda equina syndrome, paraplegia, and tetraplegia.We describe a very extensive extradural pneumorrachis (T9-S1), related to obstetric analgesia, in a patient with severe and atypical perineal pain after forceps-assisted delivery. Our aim is to synthesize and organize the available scientific evidence, analyzing preventive measures and summarizing the most appropriate diagnostic, follow-up and therapeutic techniques for symptomatic conditions, among which high concentrations of inspired oxygen, hyperbaric oxygen therapy and percutaneous or surgical decompression have been described.

Keywords:
Pneumorrhachis
Extradural
Iatrogenic
Neurological symptoms
Resumen

El neumorraquis extradural iatrogénico es una entidad clínica poco frecuente, pero los anestesiólogos debemos ser conscientes de esta posibilidad cuando se utiliza la técnica con aire para la identificación del espacio epidural. Aunque en la mayoría de los casos publicados el neumorraquis extradural es asintomático, se han descrito consecuencias neurológicas relevantes, como irritación meníngea, dolor radicular, debilidad unilateral de extremidades inferiores, síndrome de cola de caballo, paraplejia y tetraplejia.Describimos un neumorraquis extradural muy extenso (T9-S1), relacionado con la analgesia obstétrica, en una paciente con dolor perineal intenso y atípico tras un parto asistido con fórceps. Nuestro objetivo es sintetizar y organizar la evidencia científica disponible, analizando las medidas preventivas y resumiendo las técnicas diagnósticas, de seguimiento y terapéuticas más adecuadas ante cuadros sintomáticos, entre las que se han descrito altas concentraciones de oxígeno inspirado, oxigenoterapia hiperbárica y descompresión percutánea o quirúrgica.

Palabras clave:
Neumorragia
Extradural
Iatrogénica
Síntomas neurológicos

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