Cardiac arrest associated with pneumorrhachis and pneumocephalus after epidural analgesia: two case reports

BACKGROUND: Epidural analgesia has become a common procedure to provide excellent pain relief with few complications. Pneumorrhachis and pneumocephalus are rare complications of unintentional dural puncture and injection of air into the subarachnoid or subdural space. No cases of cardiac arrest associated with these complications have been reported in the literature previously. CASE PRESENTATION: We report cases of pneumorrhachis and pneumocephalus in two Korean women who previously visited a local pain clinic and underwent epidural analgesia. Thereafter, they were admitted to the emergency department with cardiac arrest. Cardiopulmonary resuscitation was performed on these patients, and return of spontaneous circulation was achieved. The brain and spine computed tomographic scans showed pneumorrhachis and pneumocephalus, respectively. These cases demonstrate that pneumorrhachis and pneumocephalus may occur after epidural analgesia, which may be associated with cardiac arrest in patients. CONCLUSIONS: If cardiac arrest occurs after epidural analgesia, pneumocephalus and pneumorrhachis should be considered as its cause. Although epidural analgesia is a common procedure, caution is warranted during this procedure.