Images in Cardiothoracic Medicine and Surgery

Accidental pleural puncture by thoracic epidural catheterization

Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(3) 343 ß The Author(s) 2013 Reprints and permissions: DOI: 10.1177/0218492313516117

Jen-Hsuan Huang, Chih-Jen Hung and Chih-Cheng Wu

Figure 1. The thoracic epidural catheter is seen in the opened chest cavity, and the 6-cm mark (arrow) of the catheter can be seen near the pleural wall.

A 68-year-old woman with morbid obesity was scheduled for radical lobectomy via thoracotomy for a right lower lobe malignancy. Before induction of general anesthesia, she received thoracic epidural catheterization for postoperative pain control. An 18-gauge Tuohy needle was inserted at the T7-8 interspace with

a paramedian approach. A loss of resistance to air was obtained at a depth of 7 cm, and an epidural catheter was threaded and advanced 6 cm beyond the introducer needle tip. Due to limitation of time, the level of sensory block was not accessed. As the chest cavity was entered, the surgeon found the epidural catheter lying in the right pleural cavity, with the 6-cm mark clearly visible (Figure 1). The operation and anesthesia proceeded unremarkably, and the intrapleural catheter was withdrawn at the end of operation. The patient was discharged on the 6th postoperative day without any sequelae. Performing thoracic epidural catheterization and assessing the efficacy prior to general anesthesia is highly recommended. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflicts of interest statement None declared.

Department of Anesthesiology, Taichung Veterans General Hospital, Taichung City, Taiwan Corresponding author: Jen-Hsuan Huang, MD, Department of Anesthesiology, Show Chwan Memorial Hospital No. 542, Sec. 1, Chung-Shan Rd., Changhua City, Taiwan 50008. Email: [email protected]

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Accidental pleural puncture by thoracic epidural catheterization.

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