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PEDIATRIC ANESTHESIA

An Epidural Hematoma in an Adolescent Patient After Cardiac Surgery

David A. Rosen, MD^*,, Denzil W. Hawkinberry, II, MD^*, Kathleen R. Rosen, MD^*,, Robert A. Gustafson, MD^,, Jeffery P. Hogg, MD, and Lynn M. Broadman, MD^*,

Departments of *Anesthesiology, Pediatrics, Surgery, and Radiology, West Virginia University Children’s Hospital, West Virginia University School of Medicine, Morgantown

Address correspondence and reprint requests to David A. Rosen, MD, Robert C. Byrd Health Science Center, West Virginia University School of Med, PO Box 9134, Morgantown, WV 26506-9134. Address e-mail to rosend{at}rcbhsc.wvu.edu

An 18-yr-old patient had a thoracic epidural placed under general anesthesia preceding an uneventful aortic valve replacement with a bioprosthetic valve. On the second postoperative day, he was anticoagulated and also received an antithrombotic medication. While ambulating, he experienced pain in his back, and there was blood in his epidural catheter. The catheter was removed, and he developed motor and sensory loss. Rapid surgical decompression resulted in recovery of his lost neurological function. Management and strategies for preventing this problem are discussed.

IMPLICATIONS: Epidural hematoma is a rare complication of epidural anesthesia and has not been reported in pediatric patients undergoing cardiac surgery. The successful treatment of this complication requires swift recognition, diagnosis, and surgical intervention.

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