Intravenous literature: Hussain, W. and Gupta, P. (2010) A rare anesthetic complication involving central line access during lumbar spine surgery: a case report and review. Spine. 35(1), p.E31-4.
STUDY DESIGN: A case report describing a rare perioperative complication involving the intrathoracic placement of a central venous catheter during spine surgery leading to hemodynamic instability.
OBJECTIVE: To review the efficacy of central line use in perioperative spine patients and to describe the diagnosis, emergent treatment, and postoperative care of a unique case of intrathoracic extravasation of propofol.
SUMMARY OF BACKGROUND DATA: Although placement of central line access is a safe procedure, complications can occur. A case in which a venous catheter delivering propofol into the thorax has never been documented.
METHODS: A 48-year-old woman presented for revision spine surgery, and a central line was placed. After placement of spinal instrumentation, she became hemodynamically unstable secondary to mediastinal compression caused by pressure from intraoperative propofol and fluid insufflation.
RESULTS: A chest tube was placed, and with aggressive pulmonary toilet and physical therapy, she did well and was discharged without noted symptoms.
CONCLUSION: The efficacy of central line use should be carefully considered in perioperative spine surgery, and in patients with significant risk factors, placement of central venous access should be radiographically confirmed.