A Study of Correlation between Epidural and CSF Pressure / 대한마취과학회지

A continuous leakage in association with hypovolemia and hypotention of the cerebrospinal fluid is the primary cause of a post-spinal headache. The spinal blood patch is known to be the best choice of treatment for a severe postspinal headache, and measurements of cerebrospinal fluid pressure with saline injection into the lumbar spinal space have been reported. However, a dynamic correlation of the pressure change between epidural and CSF pressure after the epidural injection of the volume has not been known. This study was primarily carried out to investigate dynamic changes and the correlation between epidural and CSF pressure with and without epidural volume injection so that it would be helpful to understand the mechanism as to the immediate and permanent cure, and recurrence of post-spinal headache. Twenty cases were divided into two groups: Group I (control): Normal CSF and epidural pressure were measurd in a sitting position (10 cases) and in a lateral position (10 cases). Group II: CSF and epidural pressure after the injection of 2% lidocaine 10 ml were measured in a sitting position (10 cases) and in a lateral position (10 cases). The differences between CSF and epidural pressure from groups I and II were calculated. The rusults were as follows. CSF pressure: The mean Mean opening pressure was 37.3+/-4.2 cm H2O, mean pressure after injeciton was 41.3+/-6.1 cm H2O and pressure rise was 4 cm H2O (10.7%) in the sitting position, and the mean opening pressure was 9.3+/-3.8 cm H2O mean pressure after injection was 13.9+/-5.2 cm H2O and pressure rise was 4.6 cm H2O (49.5%) in the lateral position. Epidural pressure: The mean initial pressure was 5.82.6 cm H2O, mean pressure after injection was 16.9+/-12.4 cm H2O and pressure rise was 22.7 cm H2O (391.3%) in the sitting posittion, and mean initial pressure was 6.1+4.0 cm H2O, mean pressure after injection was 9.5+ 7.9 cm H2O, and pressure rise was 15.6 cm H2O (255.7%) in the lateral position. Difference between CSF and epidural pressure (CSF pressure-epidural pressure, cm H2O): The mean pressure difference in the control group was 43.1+5.7 cm H2O and mean pressure difference after injection was 24,4+/-12.4 cm H2O in sitting position, and mean pressure difference in the control group was 15.4+/-4.1 cm H2O and mean pressure difference after injection was 4.4+/-10.1 cm H2O in lateral position. It is obvious that the injection of 10 ml of 2% lidocaine reduced the pressure difference greatly between the subarachnoid and epidural spaces. These results indicate that the volume of 10 ml is suitable for an epidural blood patch and it suggests that the patient must be placed in a supine or lateral position immediately after an epidural blood patch is done because of the equalizing of the pressure difference. However, there was still a small difference in pressure between the two compartments: The CSF pressure being higher than the epidural pressure.

Comparison of Normal Gas Values in the CSF , Arterial and Venous Blood between Young and Old Age / 대한마취과학회지

Normal values of CSF gases in young Koreans were reported by Song and Jeon as follows: PcsfO2 76.5+/-8.6 torr and PcsfCO2 44.9+/-3.6 torr. The pH of the CSF was 7.329 +/-0.017, HCO2 was 23.6+/-1.8mEq/L and the B.E. was -2.2+/-1.5. The CSF and arterial and venous blood gases of a group a relatively healthy patients aged 60~80 years scheduled for elective surgery were measured. Prior to the induction of anesthesia, lumbar tapping was performed at a level of L3-4 using a 22 gauge needle and CSF samples were obtained. Then, radial arteiral blood samples were taken. The subclavian vein was cannulated with a 20 gauge catheter and venous blood samples were collected. The gas values of this group were compared with those of the young age group as shown in the tables and figures. The results of this study were as follows: PcsfO2 was 72.76+/-10.49 otrr and PcsfO2 was 44.52+/-3.5 torr. The pH of CSF was 7.318+/-0.04. HCO3- was 22.62+/-2.5 and B.E. was 3.07+/-2.4.

Syringomyelia Associated with Arachnoiditis Developed after Spinal Anesthesia / 대한마취과학회지

The popularity of spinal anesthesia has decreased to some extent due to the widespread use of a balanced anesthesia technique, increasing interest in epidural anesthesia and fear of neurologic sequelae resulting from spinal anesthesia. The complication once most feared was adhesive arachnoiditis. However, in many study reports there were no instances of adhesive arachnoiditis, cauda equina syndrome or transverse myelitis. The majority of serious neurological symptoms appearing after spinal anesthesia can be attributed to coincidence or previously unrecognizaed disease. This is a case report in which the patient developed syringomyelia with chronic adhesive arachnoiditis. A 27-year-old patient, known to have adhesive arachnoiditis which developed after spinal anesthesia, was admitted to this institution for treatment of syringomyelia. He had history of a simple appendectomy done under spinal anesthesia on the 24th of November in 1976 and had experienced sensory changes and progressive motor weakness in the lower extremities 4 months after surgery. In January, 1978 he received an adhesiolysis operation after conservative therapy using steroid injections. Afterward, he developed syringomyelia resulting from adhesive arachnoiditis and had shunt surgery. He went home without significant improvement. However, it is unwise to make a final diagnosis and assume that the sequela was attributed only to the spinal anesthesia. It is important to seek other causes rather than to ascribe all to the spinal anesthesia because there are many other causative factors. In this case, it was not certain that adhesive arachnoiditis was a possible cause, but this could not be ruled out either. The prevention of complications and their causative factors must be carefully considered at all times in the practice of spinal anesthesia.