Befragung über den Umgang mit neuraxial verbliebenen Fremdkörpern

A complication not often described in literature is remaining of catheter fragments in the neuraxial space. Up until now the available literature has not been sufficient to guarantee an appropriate handling of the diagnosis and therapy. The German association of anaesthesiology (DGAI), neurosurgery (DGNC), orthopaedics (DGOOC) and trauma surgery (DGU) were contacted via email and a questionnaire comprising 10 different questions was passed on to the different clinical directors, head physicians and owners of doctor ´s office. From August 2008 to May 2009, we received 130 answers to an established email post-office box. By analyzing the feedback systematically, we derived an expert based standard for handling intrathecally remaining foreign bodies. The biggest part of the answers came from anesthesiologists experienced with catheter systems and work in non-specialized hospitals. The treatments guidelines are: a catheter part remaining in an asymptomatic adult patient is no indication for surgery. A preventive antibiotic treatment is not necessary. In a symptomatic adult patient, the catheter fragment should be localized by a thin slice computed tomography. If this is not successful, an x-ray should be taken. If both diagnostic imaging tools are not successful, an operative exploration is recommended. The main indications for surgery are neurological failures, infections, loss of spinal fluid, pain and local discomfort. Relative indications for surgery are pain despite a conventional analgetic treatment, infection despite an appropriate antibiotic treatment and a certainly intrathecally placed catheter fragment. A young patient should be operated instantly because otherwise the fragment will remain in the childs body for a long time and a higher rate of complications are to be expected. The operative extraction should be planned − independently from the age of the patient − in abdominal position and general anesthesia. Starting at the entry wound, the surgical access should be done either microsurgical with a microscope or by midline incision. The intervention should be done by a neurosurgeon. Up to this point, literature was not able to provide guidelines for surgical intervention when faced with neuraxially remaining foreign bodies. Because of this questionnaire a guideline can be deduced for the first time. Conclusions: The results of this questionnaire are suitable to give first advice and establish a first expert-based standard for diagnosis and therapy in case of remaining foreign bodies in the neuraxial space. Nevertheless, the findings of this study must be supported by future prospective studies and consensus processes.