title: A rare anesthetic complication involving central line access during lumbar spine surgery: a case report and review.
abstract: METHODS
  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.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Orthopaedic Surgery and Rehabilitation, University of Chicago Pritzker School of Medicine, Chicago, IL 60616, USA. waqas.hussain@uchospitals.edu
authors.forename: Waqas
authors.initials: W
authors.lastname: Hussain
authors.forename: Purnendu
authors.initials: P
authors.lastname: Gupta
mesh_terms: D000771:Anesthesia, Intravenous / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008875:Middle Aged; D019990:Perioperative Care; D012086:Reoperation / Q000009:adverse effects; D013168:Spondylolisthesis / Q000601:surgery*; D016896:Treatment Outcome