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KMID : 0352120160310010038
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Journal of Kyung Hee University
2016 Volume.31 No. 1 p.38 ~ p.44
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Epidural Hematoma after Incidental Removal of an Epidural Catheter in a Patient Receiving Enoxaparin
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Chun Duk-Hee
Kim Jong-Chan
Kim Sun-Ok
So Eun-Sun
Kim Seong-Su
Ahn So-Woon
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Abstract
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We report a case of an epidural hematoma following a combined spinal-epidural anesthesia and analgesia. A patient undergoing total knee arthroplasty was postoperatively treated with enoxaparin for thromboprophylaxis. The patient developed the neurologic symptoms after 14 hours from the unintentional removal of an epidural catheter. And the diagnosis was delayed for 28 hours after the appearance of the first symptoms. The neurological recovery was complete even though the evacuation of the hematoma was only performed 30 hours after the appearance of the initial symptoms. One must pay attention to the delayed onset of neurologic symptoms when epidural catheters are removed earlier than intended during thromboprophylaxis. Prolonged close neurological observation, an additional fixation method and prophylactic protamine reversal may be considerable to manage the patients who use enoxaparin.
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KEYWORD
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Thromboprophylaxis, LMWH, Epidural Analgesia, Enoxaparin
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