Catheterization epidural

Du Pen SL, Peterson DG, Williams A, Bogosian AJ. Infection during chronic epidural catheterization diagnosis and treatment. Anesthesiology 1990 73(5) 905-9. 

A hypertensive crisis and myocardial infarction occurred in a 62-year-old woman after a combined injection of hydromorphone 48 mg and clonidine 12 mg subcutaneously in an attempt to refill an implanted epidural infusion pump (42). She was immediately treated with naloxone, but she subsequently had accelerated hypertension, a brief tonic-clonic seizure, and an anteroseptal myocardial infarction. Cardiac catheterization showed no coronary narrowing or blockage, but an anterior infarct was confirmed. 

A man with severe vascular disease was given general and epidural anesthesia with 2% isobaric hdocaine plus adrenaline for a popliteal distal vein bypass graft (212). The epidural inadvertently became a total spinal, which was discovered at the end of the operation. He developed cauda equina syndrome, confirmed by electromyography. He was unable to tnm or sit np by himself for a month and at 12 months was walking with a cane and needed self-catheterization and medication for neuropathic pain. 

Spigos et al. [112] adopted a strict protocol that resulted in a remarkably low number of complications. The protocol included broad-spectrum antibiotics started 8-12 hours before the procedure and continued for 1-2 weeks, local antibiotics (such as gentamicin) suspended in the solution used to deliver the particulate embolic agents and administered through the angiographic catheter, strict attention to sterility (whole-body povidone-iodine bath or wide surgical scrub at the site of catheter insertion), selective catheterization with the catheter tip beyond pancreatic branches, effective pain control with narcotics or epidural anesthesia for 48 hours (which prevents the splinting that may... 

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See also in sourсe #XX -- [ ]

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