Life-threatening hypotension triggered by wall suction-applied epidural drainage during spinal fusion surgery: A report of two cases

Negative-pressure suction drains are commonly used in spinal surgery; however, negative pressure may provoke serious intraoperative complications. Acute circulatory collapse associated with epidural drainage remains underrecognized, and its underlying mechanisms have not been fully elucidated. We report two cases of abrupt, severe hypotension without bradycardia occurring during wound closure in spinal fusion surgery. At the onset of hypotension, the skin at the suturing site was visibly indented, indicating rapid transmission of negative pressure to the epidural space upon connecting the epidural drain to wall suction. Negative pressure applied to an epidural drain may precipitate acute circulatory collapse during spinal surgery. Awareness of this potentially life-threatening complication is essential, and connecting an epidural drain to wall suction should be avoided. If circulatory collapse occurs during wound closure with negative-pressure epidural drainage, anesthesiologists should immediately request that suction be discontinued, regardless of the drainage system used.