Dural tear with severe irrigation-related complications during unilateral biportal endoscopy under general anesthesia: a case series and literature review

Key Takeaways for GI Nurses

• This case series highlights severe complications from unilateral biportal endoscopy, emphasizing the critical importance of monitoring irrigation pressures and fluid balance during endoscopic procedures under general anesthesia
• Dural tears represent a serious complication that requires immediate recognition and appropriate nursing response, including careful neurological assessment and fluid management protocols
• The irrigation-related complications described underscore the need for GI nurses to maintain vigilant monitoring of irrigation systems, including pressure settings, fluid volumes, and patient response during complex endoscopic procedures
• This research reinforces the importance of interdisciplinary communication and rapid escalation protocols when unexpected complications arise during endoscopic procedures

Clinical Relevance

While this case series focuses on spinal endoscopy rather than traditional gastrointestinal procedures, the irrigation and monitoring principles directly apply to GI endoscopy practice. Endoscopy nurses regularly manage irrigation systems during procedures such as ERCP, EUS-guided interventions, and therapeutic colonoscopies where irrigation pressure and fluid management are critical safety factors. The complications described in this research highlight the potential for serious adverse events when irrigation pressures exceed safe parameters or when excessive fluid volumes are used during procedures under general anesthesia.

The case series emphasizes the crucial role of nursing vigilance in monitoring patient response during complex endoscopic procedures. GI nurses must maintain heightened awareness of neurological changes, fluid balance alterations, and signs of systemic complications that may arise from irrigation-related issues. This is particularly relevant during lengthy therapeutic procedures where irrigation volumes can be substantial and patient positioning may compromise normal physiological responses. The research supports the need for standardized protocols regarding irrigation pressure limits, fluid volume documentation, and escalation criteria for concerning patient changes.

From a professional development perspective, this publication reinforces the importance of understanding the physiological implications of endoscopic irrigation systems beyond their immediate procedural function. GI nurses should be prepared to recognize early signs of irrigation-related complications and implement appropriate interventions, including immediate cessation of irrigation, patient repositioning, and prompt physician notification. The case series also highlights the value of comprehensive documentation of irrigation parameters and patient response, which can be crucial for identifying patterns that may predict complications.

Bottom Line

This case series serves as a critical reminder that irrigation-related complications during endoscopic procedures can result in serious adverse events, reinforcing the essential role of GI nurses in maintaining vigilant monitoring of irrigation pressures, fluid volumes, and patient response throughout all endoscopic procedures, particularly those performed under general anesthesia where patient feedback is not available to guide irrigation management.