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Acute Myelitis After Correction of Hypospadias with Caudal Anesthesia

Received: 14 February 2020     Accepted: 4 March 2020     Published: 23 April 2020
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Abstract

Combined epidural anesthesia with general anesthesia is the preferred anesthetic technique for lower limb surgery as well as lower abdominal, genitourinary and perineal surgery in children. This case report below depicts a rare complication: acute myelitis. It occurred following surgical correction of hypospadias (first stage) under combined caudal epidural anesthesia with general anesthesia in an Eight-months-old infant, weighing 9.8 kilograms, with no surgical/anesthetic history, without known allergies, previously healthy, with adequate developmental milestones, physical examination without abnormalities, without difficult airway predictors, with adequate fasting time and normal laboratorial exams. Some etiologies for this case report have been suggested such as spinal cord trauma, infectious and vascular causes, local anesthetic and noxious chemicals neurotoxicity and demyelinating diseases. In spite of thorough scrutiny, we were not able to define a single cause for the clinical manifestations. In this setting, the treatment goal was to provide support measures and rehabilitation of neurological deficits.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 8, Issue 1)
DOI 10.11648/j.ijacm.20200801.16
Page(s) 26-29
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Anesthesia, Acute Myelitis, Correction of Hypospadias, Neurological Deficits

References
[1] Suresh, S., Long, J., Birmingham, P. K., & De Oliveira Jr, G. S. (2015). Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database. Anesthesia & Analgesia, 120 (1), 151-156.
[2] Beyaz, S. G., Tokgöz, O., & Tüfek, A. (2011). Caudal epidural block in children and infants: retrospective analysis of 2088 cases. Annals of Saudi medicine, 31 (5), 494-497.
[3] Meyer, M. J., Krane, E. J., Goldschneider, K. R., & Klein, N. J. (2012). Neurological complications associated with epidural analgesia in children: a report of 4 cases of ambiguous etiologies. Anesthesia & Analgesia, 115 (6), 1365-1370.
[4] Jöhr, M. (2015). Regional anaesthesia in neonates, infants and children: an educational review. European Journal of Anaesthesiology (EJA), 32 (5), 289-297.
[5] Chen, Y., Yan, L., Zhang, Y., & Yang, X. (2019). The role of DRP1 in ropivacaine-induced mitochondrial dysfunction and neurotoxicity. Artificial cells, nanomedicine, and biotechnology, 47 (1), 1788-1796.
[6] Desparmet, J. F. (1990). Total spinal anesthesia after caudal anesthesia in an infant. Anesthesia & Analgesia, 70 (6), 665-667.
[7] Muckart, D. J., Bhagwanjee, S., & van der Merwe, R. (1997). Spinal cord injury as a result of endotracheal intubation in patients with undiagnosed cervical spine fractures. Anesthesiology: The Journal of the American Society of Anesthesiologists, 87 (2), 418-420.
[8] Strafford, M. A., Wilder, R. T., & Berde, C. B. (1995). The risk of infection from epidural analgesia in children: a review of 1620 cases. Anesthesia & Analgesia, 80 (2), 234-238.
[9] Martinez-Garcia, E., Pelaez, E., Roman, J. C., & Perez-Gallardo, A. (2005). Transverse myelitis following general and epidural anaesthesia in a paediatric patient. Anaesthesia, 60 (9), 921-923.
[10] Jha S, Kumar R. Transverse myelitis following spinal anesthesia. Neurol India. 2006 Dec; 54 (4): 425-7.
[11] Mukherjee D, Gautam S, Agarwal A, et al. Unexplained episode of sensory-motor deficit following lumbar epidural analgesia. Korean J Pain. 2019 Jan; 32 (1): 53-54.
[12] Gunaydin B, Akcali D, Alkan M. Epidural anaesthesia for Caesarean section in a patient with Devic's Syndrome. Anaesthesia. 2001 Jun; 56 (6): 565-7.
[13] Nishikawa T, Dohi S: Clinical evaluation of clonidine added to lidocaine solution for epidural anesthesia. ANESTHESIOLOGY 1990; 73: 853-9.
[14] J. B. Dahl, L. Simonsen, T. Mogensen, J. H. Henriksen, and H. Kehlet, “The effect of 0.5% ropivacaine on epidural blood flow,” Acta Anaesthesiologica Scandinavica, vol. 34, no. 4, pp. 308–310, 1990.
[15] Sviggum, H. P., Jacob, A. K., Arendt, K. W., Mauermann, M. L., Horlocker, T. T., & Hebl, J. R. (2012). Neurologic complications after chlorhexidine antisepsis for spinal anesthesia. Regional Anesthesia & Pain Medicine, 37 (2), 139-144.
[16] Torsten E. Gordh, Stina Ekman & Anne-Sofie Lagerstedt (1984) Evaluation of Possible Spinal Neurotoxicity of Clonidine, Upsala Journal of Medical Sciences, 89: 3, 266-273.
[17] Killeen, T., Kamat, A., Walsh, D., Parker, A. and Aliashkevich, A. (2012), Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review. Anaesthesia, 67: 1386-1394.
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  • APA Style

    Jeniffer Almeida Correa do Nascimento, Matheus de Castro Abi-Ramia Chimelli, Jose Eduardo Smilgevicius Silva, Marcelo Grisolia Gonçalo, Pedro Paulo Vanzillota. (2020). Acute Myelitis After Correction of Hypospadias with Caudal Anesthesia. International Journal of Anesthesia and Clinical Medicine, 8(1), 26-29. https://doi.org/10.11648/j.ijacm.20200801.16

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    ACS Style

    Jeniffer Almeida Correa do Nascimento; Matheus de Castro Abi-Ramia Chimelli; Jose Eduardo Smilgevicius Silva; Marcelo Grisolia Gonçalo; Pedro Paulo Vanzillota. Acute Myelitis After Correction of Hypospadias with Caudal Anesthesia. Int. J. Anesth. Clin. Med. 2020, 8(1), 26-29. doi: 10.11648/j.ijacm.20200801.16

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    AMA Style

    Jeniffer Almeida Correa do Nascimento, Matheus de Castro Abi-Ramia Chimelli, Jose Eduardo Smilgevicius Silva, Marcelo Grisolia Gonçalo, Pedro Paulo Vanzillota. Acute Myelitis After Correction of Hypospadias with Caudal Anesthesia. Int J Anesth Clin Med. 2020;8(1):26-29. doi: 10.11648/j.ijacm.20200801.16

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  • @article{10.11648/j.ijacm.20200801.16,
      author = {Jeniffer Almeida Correa do Nascimento and Matheus de Castro Abi-Ramia Chimelli and Jose Eduardo Smilgevicius Silva and Marcelo Grisolia Gonçalo and Pedro Paulo Vanzillota},
      title = {Acute Myelitis After Correction of Hypospadias with Caudal Anesthesia},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {8},
      number = {1},
      pages = {26-29},
      doi = {10.11648/j.ijacm.20200801.16},
      url = {https://doi.org/10.11648/j.ijacm.20200801.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20200801.16},
      abstract = {Combined epidural anesthesia with general anesthesia is the preferred anesthetic technique for lower limb surgery as well as lower abdominal, genitourinary and perineal surgery in children. This case report below depicts a rare complication: acute myelitis. It occurred following surgical correction of hypospadias (first stage) under combined caudal epidural anesthesia with general anesthesia in an Eight-months-old infant, weighing 9.8 kilograms, with no surgical/anesthetic history, without known allergies, previously healthy, with adequate developmental milestones, physical examination without abnormalities, without difficult airway predictors, with adequate fasting time and normal laboratorial exams. Some etiologies for this case report have been suggested such as spinal cord trauma, infectious and vascular causes, local anesthetic and noxious chemicals neurotoxicity and demyelinating diseases. In spite of thorough scrutiny, we were not able to define a single cause for the clinical manifestations. In this setting, the treatment goal was to provide support measures and rehabilitation of neurological deficits.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Acute Myelitis After Correction of Hypospadias with Caudal Anesthesia
    AU  - Jeniffer Almeida Correa do Nascimento
    AU  - Matheus de Castro Abi-Ramia Chimelli
    AU  - Jose Eduardo Smilgevicius Silva
    AU  - Marcelo Grisolia Gonçalo
    AU  - Pedro Paulo Vanzillota
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    N1  - https://doi.org/10.11648/j.ijacm.20200801.16
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    JF  - International Journal of Anesthesia and Clinical Medicine
    JO  - International Journal of Anesthesia and Clinical Medicine
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    EP  - 29
    PB  - Science Publishing Group
    SN  - 2997-2698
    UR  - https://doi.org/10.11648/j.ijacm.20200801.16
    AB  - Combined epidural anesthesia with general anesthesia is the preferred anesthetic technique for lower limb surgery as well as lower abdominal, genitourinary and perineal surgery in children. This case report below depicts a rare complication: acute myelitis. It occurred following surgical correction of hypospadias (first stage) under combined caudal epidural anesthesia with general anesthesia in an Eight-months-old infant, weighing 9.8 kilograms, with no surgical/anesthetic history, without known allergies, previously healthy, with adequate developmental milestones, physical examination without abnormalities, without difficult airway predictors, with adequate fasting time and normal laboratorial exams. Some etiologies for this case report have been suggested such as spinal cord trauma, infectious and vascular causes, local anesthetic and noxious chemicals neurotoxicity and demyelinating diseases. In spite of thorough scrutiny, we were not able to define a single cause for the clinical manifestations. In this setting, the treatment goal was to provide support measures and rehabilitation of neurological deficits.
    VL  - 8
    IS  - 1
    ER  - 

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Author Information
  • Department of Anesthesiology, Hospital Federal da Lagoa, Rio de Janeiro, Brazil

  • Department of Anesthesiology, Hospital Federal da Lagoa, Rio de Janeiro, Brazil

  • Department of Anesthesiology, Hospital Federal da Lagoa, Rio de Janeiro, Brazil

  • Department of Anesthesiology, Hospital Municipal Jesus, Rio de Janeiro, Brazil

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