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Dural Puncture (dural + puncture)

Distribution by Scientific Domains

Medical Sciences	100%

Terms modified by Dural Puncture

dural puncture headache

Selected Abstracts

Dural puncture with occluded Tuohy needle

ANAESTHESIA, Issue 10 2010
A. Furlonger
No abstract is available for this article. [source]

Dural punctures in children: what should we do?

PEDIATRIC ANESTHESIA, Issue 6 2002
Alexander Oliver MBBS
First page of article [source]

Real-time ultrasound-guided spinal anesthesia in patients with a challenging spinal anatomy: two case reports

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010
K. J. CHIN
Spinal anesthesia may be challenging in patients with poorly palpable surface landmarks or abnormal spinal anatomy. Pre-procedural ultrasound imaging of the lumbar spine can help by providing additional anatomical information, thus permitting a more accurate estimation of the appropriate needle insertion site and trajectory. However, actual needle insertion in the pre-puncture ultrasound- assisted technique remains a ,blind' procedure. We describe two patients with an abnormal spinal anatomy in whom ultrasound-assisted spinal anesthesia was unsuccessful. Successful dural puncture was subsequently achieved using a technique of real-time ultrasound- guided spinal anesthesia. This may be a useful option in patients in whom landmark-guided and ultrasound-assisted techniques have failed. [source]

Spread of spinal block in patients with rheumatoid arthritis

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010
K. A. LEINO
Background: In clinical practice, we noticed a greater than expected spread of sensory spinal block in patients with rheumatoid arthritis. We decided to test this impression and compared the spread of standard spinal anaesthesia in rheumatoid and non-rheumatoid control patients. Methods: Spinal anaesthesia with 3.4 ml (17 mg) of plain bupivacaine was administered to 50 patients with seropositive rheumatioid arthritis and to 50 non-rheumatoid control patients. The protocol was standardised for all patients. All the patients were undergoing lower limb surgery and the rheumatoid patients were operated on due to their rheumatoid disease. The spread of sensory block was recorded 30 min from the dural puncture using a pin prick test and a cold ice-filled container. The impact of body mass index (BMI), height and age on the spread were analysed. Results: The spread of sensory block was greater in patients with rheumatoid arthritis (15.6±3.1 dermatomes) than in non-rheumatoid patients (14.1±3.3 dermatomes) (P<0.05). Increasing BMI was related to cephalad spread of block in the rheumatoid group (P<0.05), but not in the control group. Conclusion: The mean spread of sensory block 30 min after the injection of plain bupivacaine was 1.5 segments cephalad in patients with rheumatoid arthritis than in those without this disease. BMI might be a patient-related factor contributing to the extent of the block in rheumatoid patients. These findings should be considered when performing a spinal block in rheumatoid patients. [source]

An unusual cause of dural puncture

ANAESTHESIA, Issue 6 2010
B. Pearce
First page of article [source]

The prevalence of anatomical variations that can cause inadvertent dural puncture when performing caudal block in Koreans: a study using magnetic resonance imaging

ANAESTHESIA, Issue 1 2010
J. Joo
Summary The purpose of this study was to investigate the prevalence of the anatomical abnormalities that can induce inadvertent dural puncture when performing caudal block. The anatomy of the lumbo-sacral area was evaluated using magnetic resonance imaging. In 2462 of the 2669 patients imaged, the dural sac terminal was located between the upper half of the 1st sacral vertebra and the lower half of the 2nd sacral vertebra. In 22 cases (0.8%), the dural sac terminal and the spinal canal were located at or below the 3rd sacral vertebra, and these were cases of simple anatomical variations. As regards pathologic conditions, there was one case of sacral meningocoele and 46 cases of sacral perineural cyst. In 21 cases (0.8%) out of the 46 perineural cyst cases, the cyst could be found at or below the 3rd sacral vertebra level. Inadvertent dural puncture may happen when performing caudal block in patients with such abnormal anatomy. [source]

Unrecognised dural puncture resulting in subdural hygroma and cortical vein thrombosis

ANAESTHESIA, Issue 1 2010
A. Sinha
Summary Unrecognised dural punctures are difficult to diagnose early. Failure of recognition may lead to sinister consequences. A case of unrecognised dural puncture in a young female leading to the development of subdural hygroma and cortical vein thrombosis is presented. The dilemma in the diagnosis of headache in such patients along with the significance of follow-up of all, including attempted, epidurals is also discussed. [source]

The effect of flexion on the level of termination of the dural sac in paediatric patients

ANAESTHESIA, Issue 10 2009
B-N. Koo
Summary Although the anatomy of the spinal cord and its associated structures have been well defined, the effects of body position relevant to neuraxial blockade have not been elucidated. This study was designed to determine the effect of body position on the end of the dural sac in children. After induction of anaesthesia, ultrasound examination was performed to evaluate the location of the dural sac end in the lateral position with a straight back and knee, and in the lateral position with the knees, legs, and neck flexed. The level of the end of the dural sac was determined in relation to the vertebrae. Our data demonstrate that the dural sac shifts significantly cephalad in the lateral flexed position used for neuraxial blockade (p < 0.001). These results suggest that the safety margin to avoid dural puncture during hiatal or S2-3 approach for caudal block can be increased in younger children. [source]

Spontaneous intracranial hypotension: A study of six cases with MR findings and literature review

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 5 2006
NI Sainani
Summary Spontaneous intracranial hypotension is clinically characterized by orthostatic headache and other symptoms caused by low cerebrospinal fluid pressure due to leakage of cerebrospinal fluid from dural punctures or other medical causes. The other symptoms are mainly due to traction of the cranial and spinal nerves owing to descent of the brain caused by low cerebrospinal fluid pressure. Magnetic resonance imaging is very useful in the diagnosis because of its characteristic findings. We describe the MRI findings in six cases that had variable clinical presentation. [source]

Prediction of the Distance from the Skin to the Lumbar Epidural Space in the Greek Population, Using Mathematical Models

PAIN PRACTICE, Issue 2 2005
Emmanouil Stamatakis MD
Abstract Background and Objectives:, The skin to lumbar epidural space distance (SLED) is variable, and therefore the ability to clinically predict the SLED may help increase the success of epidural anesthesia/analgesia. The goal of this study was to determine the relationship between the SLED and demographic/anthropometric variables in the Greek population, and develop a mathematical model for its prediction. Methods:, This prospective randomized study enrolled 406 male and female Greek patients who required an epidural block as part of their anesthetic management. With patients placed in the left lateral and knee-chest position, the lumbar epidural space was located by the loss of resistance to normal saline technique. Statistical analysis was used to identify the relationship between SLED, and the following variables were evaluated: age, weight, height, body mass index, body surface area, intervertebral space used, pregnancy, and geographic origin within Greece. Results:, No adverse events or dural punctures occurred. Mean SLED in the general population was 4.98 ± 0.95 cm, with values significantly higher in males (5.37 ± 0.88 cm) compared with females (4.83 ± 0.93 cm). SLED was best associated with weight, body surface area, and body mass index. Mathematical formulae for prediction of SLED in the general population and the female population were derived from linear regression analysis. These formulae were able to predict approximately half of the observed variability in SLED. Conclusions:, While mathematical models of SLED can be a useful tool, they should not be exclusively relied on in the clinical setting, but rather should be used as an adjunct to standardized techniques to improve the safety and efficacy of epidural anesthesia/analgesia. [source]