[Lymphosarcoma originating at the spinal epidural space--epidural spinal lymphoblastic lymphosarcoma].
Explore the source record for details and available documents.
Adult↗
SEARCH · Search PubMed
Results for “Epidural Space”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[Electron microscopic analysis of particles from surgical gloves and their possible introduction into the epidural space during epidural anesthesia].
OBJECTIVE: Many publications have linked surgical glove powder to inflammatory reactions of the peritoneum, pleura, pericardium and meninges. Accidental contamination may also increase the likelihood of complications after spinal and epidural anesthesia. We aimed to analyze the morphological characteristics of microscopic particles adhering to surgical gloves and to analyze how likely such particles are to enter the epidural space during catheterization. MATERIAL AND METHOD: One hundred epidural catheters were studied in two groups (A and B) of 50. Group A catheters contained stylettes and the distal ends were open (Vygon). Group B catheters contained no stylettes and had closed distal ends and three side openings (Becton Dickinson). Continuous epidural anesthesia was simulated with half the catheters in each group (25) by touching the distal end of each line with the gloves and later inserting the catheter through a Tuohy needle. All catheters--those used in the simulation as well as the untouched ones--were then examined under a scanning electron microscope. The particles on the internal and external surfaces of the gloves had previously been identified under a microscope and analyzed by X-ray diffraction. RESULTS: Gloves: external glove surfaces carried particles measuring between 3 and 4 mu; their morphology was consistent with calcium carbonate. On internal surfaces we found larger particles, between 11 and 14 mu in diameter, shaped differently and of smooth appearance. Analysis of the latter showed them to contain traces of magnesium and to have characteristics consistent with organic molecules. The particles of one surface were never observed on the other. Catheters: the non-manipulated catheters in both groups contained no free particles matching those described above, whereas the outside surfaces of the catheters in contact with gloves contained particles consistent with those of external glove surfaces. The number of particles per square millimeter of surface was 2,598 (95% CI 2,200 to 2,900) in group A catheters and 2,340 (95% CI 2,000 to 2,600) in the group B catheters (p = NS). The differences in the number of particles adhering to catheters touched by gloves and those that had not been manipulated were statistically significant (p < 0.001). CONCLUSIONS: Particles adhering to gloves can be drawn into the epidural space during continuous epidural anesthesia. All unnecessary manipulation should therefore be avoided, and the portion of the catheter to be inserted into the epidural space should not be touched in order to prevent possible nonspecific meningeal inflammatory responses.
Anesthesia, Epidural↗
[Ultrasonography and peridural anesthesia. Technical possibilities and limitations of ultrasonic examination of the epidural space].
Epidural anaesthesia (EA) is the most important analgesia technique in obstetrics for delivery. In pregnancy, hormonal adjustments lead to an alteration of tissue consistency, which often causes an early, untimely loss of resistance. Apart from mere inspection and palpation, no useful diagnostic method prior to EA performance has been established yet. In this prospective study, we examined 100 pregnant women, who had been admitted for childbirth and were undergoing epidural block (level L3-L4) for delivery. Sonotopography of the lumbar epidural structures was performed directly before epidural puncture and childbirth. We evaluated the visibility of all anatomical structures and compared all distances measured by ultrasonography and during puncture. The correlation between distances measured by ultrasound and by puncture needle was high (r2 = 0.79). No obvious dependency was found between ultrasonic and puncture angle (r2 = 0.19). The temporal distance from ultrasonic examination and puncture causes unavoidable differences: each deviation between ultrasound and puncture conditions causes a modification of the puncture depth. The patient acceptance of the procedure was very good. Ultrasonography offers the possibility to determine site and direction of epidural puncture and distance of the epidural space to the skin even before the puncture attempt. The ultrasound controlled EA for delivery can easily be inserted into the clinical routine. Ultrasonography can fill an important diagnostic gap in regional anaesthesia.
Adult↗
Epidural venography: diagnosis of herniated lumbar intervertebral disc and other disease of the epidural space.
Epidural venography is a simple and safe procedure for the diagnosis of herniated intervertebral disc and other disease of the epidural space. It is especially useful in symptomatic patients with normal or equivocal myelographic findings. The accuracy rate of positive venograms is 88.2% in this series of 58 patients. Five illustrative cases are presented.
Adult↗
Prediction by computerised tomography of distance from skin to epidural space during thoracic epidural insertion.
In this single group observational study on 29 patients, we describe a technique that predicts the depth of the epidural space, calculated from the routine pre-operative chest computerised tomography (CT) scan using Pythagorean triangle trigonometry. We also compared the CT-derived depth of the epidural space with the actual depth of needle insertion. The CT-derived and the actual depths of the epidural space were highly correlated (r = 0.88, R2 = 0.78, p < 0.0001). The mean (95% CI) difference between CT-derived and actual depths was 0.26 (0.03-0.49) cm. Thus, the CT-derived depth tends to be greater than the actual depth by between 0.03 and 0.49 cm. There were no associations between either the CT-derived or the actual depth of the epidural space and age, weight, height or body mass index.
Adult↗
A 'membrane in syringe' technique that allows identification of the epidural space with saline while avoids injection of air into the epidural space.
BACKGROUND: The 'MEMBRANE IN SYRINGE' technique is, in principle, a modification of the loss of resistance technique for identifying the epidural space in epidural anaesthesia. A plastic membrane is placed halfway inside a syringe dividing the syringe into two compartments. The saline compartment encompasses the nozzle of the syringe (the distal compartment). The plunger is installed in the opposite half of the hallow cylinder. Air is trapped in the space between the membrane and the rubber plunger (air compartment). METHODS: There were altogether 20 epidural procedures to put to the test for this technique. The time spent in the undertaking of the procedure, the amount of normal saline injected, whether there was a feel of loss of resistance with wrinkling of the membrane in the syringe, inadvertent puncture of the dura, the level of epidural block and the insertion depth of epidural needle were recorded. RESULTS: The procedure took less than 4 minutes to complete in most of the cases. There was no inadvertent dural puncture. The average amount of normal saline injected was less than 1 ml. In 3 cases, despite the absence of the feel of loss of resistance the epidural space was still successfully identified by visible wrinkling of the membrane in the syringe. All catheters were inserted smoothly through the epidural needle and appropriate level of anesthesia was achieved in all the cases. CONCLUSIONS: The advantage of this technique is twofold. Firstly when the syringe is filled with both normal saline and air, it can prevent injection of the air into the epidural space during identification while at the same time it does not molest the feel of compressibility. Secondly, with the membrane separating the normal saline and air, correct placement of the needle tip can also be ascertained with loss of resistance while, as will be seen, the plastic membrane will wrinkle when saline is released into the epidural space.
Adolescent↗
Epidural space as a Starling resistor and elevation of inflow resistance in a diseased epidural space.
BACKGROUND AND OBJECTIVES: The origin and the presence of negative pressure in the epidural space as well as the relationship of the extent of epidural anesthesia to epidural pressure has long been a subject of controversy. To further elucidate epidural pressure and its time course, the pressure at the needle tip was continuously measured as it traversed the interspinous ligament and the ligamentum flavum. METHODS: In a group of 22 patients, fluid was infused under gravity, and in a second group of 25 patients, boluses of fluid were administered at controlled infusion rates and under gravity. The volume-pressure-flow relationship was thus measured in one of two ways, either with a manual syringe and pressure transducer or with a pressure-monitoring-computer-controlled volumetric infusion pump. RESULTS: Natural pressure, (i.e., pressure in the epidural space before instrumentation is applied) could be approached when the space was first entered before fluid was infused (initial pressure); or after fluid had been infused (residual pressure). Epidural pressure could be extrapolated from the upsweep of the volume-pressure-flow relationship by projecting it back to just before the first injection. The extrapolated pressure lay between the initial and residual pressures. Medicinal solution placed in the barrel of the syringe did not infuse under gravity until the syringe barrel was lifted to a certain height, at which flow began and continued at a perceptible rate, with very little or no further increase in height required to maintain flow. The pressure at which flow began was the critical opening pressure, a characteristic of a Starling resistor. Furthermore, resistance to inflow of fluid was related to the presence or absence of natural or surgical disease in the epidural space. Resistance was significantly higher in the diseased than in the surgical group, at 114 (range, 22-226) mm Hg/L/h versus 46 (range, 8-86) mm Hg/L/h. Three phases were seen in the pressure-time recordings. CONCLUSIONS: Volume-pressure-flow relationships in the epidural space can be explained by a model in which epidural and subarachnoid pressures are inextricably related with the Starling pressure, dependent on the subarachnoid pressure. This model suggests reasons why spread of anesthetics might be difficult to predict.
Adult↗
Distance from the skin to the cervical epidural space.
BACKGROUND: Cervical epidural blockade provides effective regional analgesia in clinical anesthesia and pain clinics. However, the risk for performing cervical epidural block is higher than lumber epidural anesthesia. We studied the distance from the skin to the cervical epidural space to determine whether there is any relationship between patient age, height, body weight, body mass index (BMI) and the distance from the skin to the epidural space. METHODS: The study included 34 patients who underwent cervical epidural analgesic for orthopedic or plastic surgery. Cervical epidural catheterization was performed at C7-T1 intervertebral space by a midline approach with a 18-G Touhy needle. The depth of the epidural space from the skin was measured by a standard ruler. RESULTS: The distance from the skin to the cervical epidural space at C7-T1 interspace was 4.81 +/- 0.81 cm (mean +/- SD). Linear regression analysis revealed significant correlation between body weight (r2 = 0.53, p < 0.0001), BMI (r2 = 0.58, p < 0.0001) and the depth of the cervical epidural space. CONCLUSIONS: These results indicated that body weight and BMI could be a guideline for identification of epidural space during cervical epidural anesthesia.
Adolescent↗
[Culture of the irrigating fluid of the epidural space obtained during chronic epidural catheterization].
The most serious complication during long-term epidural catheterization is epidural infection. Bacterial culture of the irrigating fluid of epidural space was carried out periodically in 39 patients in whom epidural catheters were inserted for a long period of time. Eight (17%) of 47 samples of epidural irrigating fluid were contaminated by the normal skin flora. All of these cases were accompanied with epidural contamination by the same organisms. No significant correlation was found between clinical signs of infection (low grade fever, leucocytosis and localized infective signs at the puncture site) and the contamination of the epidural irrigating fluid or that of the epidural catheter. When epidural irrigating fluid was contaminated, the epidural catheter was removed immediately and the patient was treated by antibiotics. None of the patients had epidural abscess or neurological deficit. In conclusion, bacterial culture of epidural irrigating fluid is valuable for the early diagnosis of epidural infection during long-term epidural catheterization.
Adult↗
Tissue reaction of morphine applied to the epidural space of dogs.
Epidural morphine has found increasing popularity in clinical trials for the relief of chronic and postoperative pain relief. This study was conducted to determine if there was any adverse tissue reaction when morphine was applied to the epidural space of dogs. Sixteen dogs were given 0.07 mg X kg-1 of morphine in a volume of 2 cc of normal saline into the epidural space. Gross and microscopic studies of the epidural space, dura, and spinal cord did not show any adverse tissue reaction.
Anesthesia, Epidural↗
Prediction of the distance from skin to epidural space for low-thoracic epidural catheter insertion by computed tomography.
BACKGROUND: It may be clinically useful to predict the depth of the epidural space. METHODS: To investigate the accuracy of preoperative abdominal computed tomography (CT) in prediction of the distance for low-thoracic epidural insertion, a single group observational study was conducted in 30 male patients undergoing elective major abdominal surgery requiring epidural analgesia for postoperative pain relief. Using the paramedian approach, low-thoracic epidural insertion at T10-11 interspace was performed with a standardized procedure to obtain an actual insertion length (AIL). According to the principles of trigonometry, an estimated insertion length (EIL) was calculated as 1.26 times the distance from skin to epidural space measured from the preoperative abdominal CT. RESULTS: The mean (SD) EIL and AIL were 5.5 (0.7) and 5.1 (0.6) cm, respectively, with a significant correlation (r=0.899, P<0.01). The EIL tended to have a higher value than the AIL (0.4 (0.3) cm). There were significant correlations of both EIL and AIL with weight (P<0.01), BMI (P<0.01), and body fat percentage (P<0.01), but not with height (P>0.05). CONCLUSIONS: We conclude that the preoperative abdominal CT is helpful in prediction of the distance for low-thoracic epidural insertion using the paramedian approach.
Abdomen↗
[Effects of different positions for epidural block on skin-epidural space distance].
Epidural block was performed in the same intervertebral space by both approaches with either flank position or prone position under fluoroscopy. The distances from with both positions the skin to the epidural space (SED) were compared. The prone position approach under fluoroscopy resulted in a significantly greater SED in both T2/3 puncture and L4/5 puncture groups. This was assumed to be due to the fact that the prone position approach does not always allow minimum distance. It was also thought to be due to the fact that in this position, compared with the flank position, a pillow is inserted under the thoracic (or abdominal) region, and the skin in the dorsal region is looser and the subcutaneous tissue is thicker. The lumbar vertebrae form the lordosis, and it does not disappear when the pillow is placed under the abdominal region. This causes the SED to be greater.
Adult↗
Cephalad distribution of three differing volumes of new methylene blue injected into the epidural space in adult goats.
Epidural anesthesia and analgesia are popular regional anesthetic techniques in many animal species. However, we have not found any reports of studies in animals that have investigated the extent of cephalad migration and level of sensory blockade achieved based only on the volume of drug injected into the epidural space. The purpose of this study was to determine if there is a relationship between the volume (mL/kg) of an injectate injected epidurally and the extent of its cephalad migration within the epidural space. Twelve adult goats were randomly assigned to three treatment groups based on the volume of 0.12% New Methylene Blue (NMB), 0.1, 0.2, or 0.3 mL/kg, injected into the epidural space. The site and speed of injection, animal position, and direction of needle bevel were held constant. All injections were performed at the lumbo-sacral space immediately following euthanasia. At necropsy, the vertebral columns were transected longitudinally. The extent of cephalad migration of dye within the epidural space was easily determined by staining of the dura. Measurements were rounded to the nearest intervertebral space to which the dye had migrated. The individual making assessments was blinded to all treatments. In goats treated with 0.1, 0.2, or 0.3 mL/kg NMB, the number of stained spinal segments was 3.5 +/- 0.6, 6.5 +/- 0.9, and 8.8 +/- 0.6, (mean +/- SEM), respectively. Linear regression performed on the data was significant (P < .05) with R2 = 0.86. There was a strong linear relationship between volume (mL/kg) of epidurally injected NMB and cranial migration, with the larger volumes producing more cephalad spread within the epidural space. These results provide evidence for the volume of epidural injectate needed to produce a desired level of sensory blockade in adult goats.
Animals↗
A comparison of epidural pressures and incidence of true subatmospheric epidural pressure between the mid-thoracic and low-thoracic epidural space.
BACKGROUND: Differences in epidural pressure (EP) may influence the spread of blockade in thoracic epidural anesthesia. We evaluated if EP and the incidence of subatmospheric EP differ between the mid- and low-thoracic epidural space. METHODS: Patients received an epidural catheter at the T3-5 (MID group, n = 20) or T7-10 (LOW group, n = 20) intervertebral space, respectively. The epidural space was identified using a Tuohy needle connected to a pressure transducer, after which EP was measured. RESULTS: The epidural space could not be identified in three patients who were excluded from the study. EP data are presented as median value (interquartile range). Median EP was 1 mm Hg (-1 to 4.5) in the MID group, and 4 mm Hg (2-7.8) in the LOW group (P = 0.04). The incidence of an EP <or=0 mm Hg was 8 of 17 patients in the MID group and 2 of 20 patients in the LOW group (P = 0.02). CONCLUSIONS: We conclude that EP is lower, and the incidence of subatmospheric EP is higher in the mid-thoracic epidural space when compared with that in the low-thoracic epidural space. However, median EP was positive in both groups. It remains to be investigated whether this pressure gradient is sufficient to influence the spread of thoracic epidural blockade.
Adult↗
Quantitative anatomy of the thoracolumbar epidural space.
Quantitative measurements of the epidural space between T-7 and L-4 were made in the sagittal and coronal planes utilizing x-ray films made after the injection of iodized oil into the epidural space in the low thoracic and upper lumbar areas. These data reveal a 1-mm ventral epidural space and a 2-mm lateral epidural space, with a sawtooth shape to the dorsal epidural space measuring between 1.1 and 2.9 mm at the rostral lamina and between 3.8 and 6.5 mm at the caudal lamina. Additionally, five patients with chronic pain were studied by computed tomography of T-8 to T-12, with confirmation of the sawtooth shape of the dorsal epidural space. Computed tomography showed the measurements of the epidural space at the rostral lamina to vary between 1.3 and 1.6 mm and those at the caudal lamina/interlaminar space to range from 6.9 to 9.1 mm.
Epidural Space↗
[The distance from the skin to the epidural space in general population].
Epidural block is a common regional anesthetic technique in surgical procedures. The depth of the epidural space beneath the skin surface varies at different levels of the spinal column in the same patient. It also varies from patient to patient at the same vertebral level. We studied the distance from the skin to the different lumbar epidural space in general population to determine whether there is any systematic relationship between patient age, height, weight and the distance from the skin to the epidural space. Data were gathered from 159 patients (excluded all obstetric cases) having epidural anesthesia for surgical procedures. All blocks were performed using a midline approach with lateral and knee-chest position. They divided into 3 group according to different lumbar area: (1) Group A: L1-2 interspace, 33 cases; (2) Group B:L3-4 interspace, 54 cases; (3) Group C: L4-5 interspace, 72 cases. Data were analyzed by single linear regression and one-way ANOVA with p less than 0.05 considered statistically significant. The results revealed that: In Group A, there were relationship between patient age [r2 = 0.137, p less than 0.05], weight [r2 = 0.35, P less than 0.0003] and weight-height ratio.[r2 = 0.36, P less than 0.0002] with the distance from the skin to the epidural space (depth); but no relationship between body height.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[The distribution of solutions in the epidural space].
In 21 patients the distribution within the epidural space of epidurally injected 99mTc-DTPA was assessed. The gamma emissions from the epidural space were measured externally with the patients in supine position by use of a gamma camera. The recordings over the patient's back were stored in digital computer for 60 min. The results were as follows; 1) The spread of the radionuclide was mainly to cephalad direction, and seldom crossed the L5 level to sacral region. 2) The solution injected in the epidural space would distribute to less resistant compartments and the spread depends on the power of injection, negative pressure in the high epidural space and capillary pressure. 3) The elimination half-life of the injected radionuclide was between 1 to 17 min depending on the region in the epidural space. 4) The solution injected in the epidural space may penetrate dura mater at the ink cuff area and local anesthetic agents may affect the spinal nerve roots in the subarachnoid space rather than at the extra-dural space. 5) With continuous infusion technique the diffusion and penetration of the local agent through the dura mater are facilitated and more profound anesthetic effects would be expected. In clinical practice the utilization of the continuous infusion method should be considered along with the bolus injection.
Adult↗
Mathematical analysis of epidural space location.
BACKGROUND: The location of epidural space for local anaesthetic injection can be difficult. The aim of this study was to define the mathematical function of the pressure changes in the syringe during puncture of the epidural space. Knowledge of pressure changes might be of help to the anesthetist who attempts to ascertain the location of the needle, and it is essential to the design of a device with which to locate epidural space. METHODS: Epidural punctures were performed in 20 patients, using an 18-Tuohy needle connected to a 10 ml syringe. The epidural space was located by the loss of resistance technique. Pressure variations within the injection system during epidural puncture were measured and digitized at 250 Hz. Pressure curves were analyzed for amplitude and rate of a decay after entry of the needle into the epidural space. RESULTS: Pressure increased as the needle passed through skin, subcutaneous fat and muscle. The maximal pressure was observed when the needle perforated the ligamentum flavum (689 +/- 124 cm H2O). When the needle entered the epidural space, an exponential decrease in pressure was observed in all patients (R2 = 0.99; tau = 2.1 +/- 0.9 seconds). End-residual pressure was 22 +/- 12 cm H2O. The change in pressure observed when the needle entered the epidural space fitted a negative exponential function (y = e-x/2.08). CONCLUSIONS: Pressures within the injection system for epidural puncture can reach 1100 cm H2O. Location of the epidural space is characterized by an exponential decay to and end-residual pressure below 50 cm H2O, with a constant time of approximately 2 seconds.
Adolescent↗