Case Report

Epidural Hematoma Associated with Dextran Infusion

Authors: Jesse J. Muir, MD, Eric J. Church, MD, Kent P. Weinmeister, MD

Abstract

Epidural anesthesia is commonly used in patients undergoing revascularization procedures of the lower extremities and other surgical procedures. Complications of epidural anesthesia are uncommon and are usually related to dural puncture or side effects of the medications being infused. Epidural hematoma is a rare complication of epidural anesthesia. Patients who undergo anticoagulation therapy generally are not considered candidates for epidural anesthesia. Management of patients in whom anticoagulation is planned is more problematic. It is generally considered safe to administer low-dose subcutaneous or intravenous standard (unfractionated) heparin as long as the needle puncture is performed 1 hour before heparin administration and the epidural catheter is removed when bleeding study results are normal. 1 Dextran is a colloid that was commonly used for volume resuscitation. This use is now uncommon because of adverse reactions associated with infusion of large volumes. These adverse reactions include anaphylactoid reactions and antithrombotic actions. Some vascular surgeons use the antithrombotic actions of dextran to promote graft patency by using low-dose infusions after peripheral revascularization. 2 We believe that this is the first description of epidural hematoma in association with dextran infusion.

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