The 28-gauge catheter supplied by Kendall Healthcare Products Company (Mansfield, MA) for continuous spinal anesthesia has two important characteristics. The ink used for the centimeter calibration marks and to identify the tip of the catheter "washes off" while it is inserted in the patient. In addition, the catheter has a tendency to stretch while it is in the patient or being removed. These two characteristics produced a situation in which it was impossible to determine whether a catheter fragment had been left in a patient. This predicament had a serious impact on the postoperative management of the patient. A computerized tomographic scan and spine films were negative, while other evidence suggested that a fragment was left behind. When the patient developed a postdural puncture headache, the authors felt that an epidural blood patch was contraindicated. The patient's headache did resolve with 48 hours of conservative therapy.

Adult↗

PubMedDate not supplied

A series of truly failed spinal anesthetics.

This report describes five patients with failed continuous spinal anesthetics with lidocaine. Lidocaine concentrations of 420 to 880 micrograms/ml were assayed in the spinal fluid despite lack of anesthesia. There was free flow of cerebrospinal fluid (CSF) through the catheter in all patients before and after the injection of lidocaine. Inactive lidocaine was not responsible for the failures, since lidocaine from the same manufacturing batch produced anesthesia in other patients. Incorrect catheter placement could not explain the failures, since bupivacaine injected through the same intraspinal catheter produced anesthesia in four of the five patients. The authors, therefore, suggest that some patients have a physiologic resistance to lidocaine.

Adult↗

PubMedDate not supplied

Blind oral intubation directed by capnography.

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Carbon Dioxide↗