Anesthetic management of spontaneous cervical epidural hematoma during pregnancy: a case report

• Published in: Journal of medical case reports Vol. 11; no. 1; p. 171
• Main Authors: Samali, Mehdi, Elkoundi, Abdelghafour, Tahri, Achraf, Bensghir, Mustapha, Haimeur, Charki
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 26.06.2017; BioMed Central; BMC
• Subjects: Adult; Airway Management - methods; Anesthesia; Anesthesia, General - methods; Care and treatment; Case Report; Case reports; Cervical Cord - diagnostic imaging; Cervical Cord - surgery; Complications and side effects; Development and progression; Emergency Treatment; Female; Fiberoptic bronchoscope intubation; Health aspects; Hematoma; Hematoma, Epidural, Spinal - physiopathology; Hematoma, Epidural, Spinal - surgery; Humans; Hypnotics and Sedatives - administration & dosage; Intubation; Laminectomy - methods; Paralysis; Peridural anesthesia; Pregnancy; Pregnancy Complications, Hematologic - physiopathology; Pregnancy Complications, Hematologic - surgery; Pregnancy Trimester, Second; Pregnant women; Propofol - administration & dosage; Radiography; Spinal cord; Spontaneous cervical epidural hematoma; Surgery; Ultrasonic imaging; Pregnancy; Anesthesia; Fiberoptic bronchoscope intubation; Spontaneous cervical epidural hematoma
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-017-1335-y

Spontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. Therefore, there is little data in the literature regarding anesthetic management of cervical localization during pregnancy. The potential for difficult airway management with the patient under general anesthesia is one of the major concerns that needs to be addressed to prevent further cord compression. Anesthetic management should also include measures to maintain the mean arterial pressure to improve spinal cord perfusion. Furthermore, spine surgery in pregnant patients needs special consideration in terms of positioning and in the postoperative period. We present a case of a 35-year-old white woman at 21 weeks of gestation with a spontaneous cervical epidural hematoma. Fiberoptic bronchoscope-guided nasal intubation was a safe option to ensure a higher rate of successful endotracheal intubation while minimizing the risk of aggravating the injury. Her care posed other multiples challenges that required a multidisciplinary team approach. The case of our patient serves as a reminder of this rare condition and its implications regarding anesthesia.