Pneumorrhachis complicating acute pain management using a thoracic epidural catheter
Bibliographic record
Abstract
The use of thoracic epidural catheters to infuse local anaesthetics and opioids is a common practice in acute pain management to attenuate the pain associated with thoracic and abdominal surgical procedures. The placement and maintenance of epidural analgesia is known to be associated with a variety of potential complications. A rare complication is the development of air of within the spinal canal (pneumorrhachis). Although pneumorrhachis is typically asymptomatic and resolves spontaneously, it rarely can be associated with neurological dysfunction. Here we describea case of pneumorrhachis that led to symptomatic acute spinal cord compression in a 27 year old man who had a thoracic epidural placed to help with pain management following laparotomy for the management of Crohn’sdisease. Postoperatively, the patient developed unilateral weakness in his upper and lower extremities and sensory dysfunction in the upper extremity. Urgent neuroimaging demonstrated epidural air causing mass effect on the cervical spinal cord. His symptoms resolved completely following conservative management. This rare presentation of pneumorrhachis highlights the need for close vigilance regarding neurological function in patients with epidural catheters for acute pain management. This presentation also promotes mitigation of factors that may be associated withthe administration of air into the epidural space, such as changing epidural infusion solution bags and malfunction of epidural infusion pumps.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".