JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Visser, W. A. Articles by Scheffer, G. J. Search for Related Content PubMed PubMed Citation Articles by Visser, W. A. Articles by Scheffer, G. J. Related Collections Regional Anesthesia

---

ANALGESIA

A Comparison of Epidural Pressures and Incidence of True Subatmospheric Epidural Pressure Between the Mid-Thoracic and Low-Thoracic Epidural Space

W. Anton Visser, MD^*, Mathieu J. M. Gielen, MD, PhD, Janneke L. P. Giele, MSc, and Gert J. Scheffer, MD, PhD

From the *Department of Anesthesiology, Intensive Care and Pain Management, Amphia Hospital, 4800 RL Breda, The Netherlands; and Department of Anesthesiology, University Medical Center Nijmegen, 6500 HB Nijmegen, The Netherlands.

Address correspondence to W. Anton Visser, MD, Department of Anesthesiology, Intensive Care and Pain Management, Amphia Hospital, PO Box 90157, 4800 RL Breda, The Netherlands. Address e-mail to avisser{at}amphia.nl.

Abstract

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 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.

This article has been cited by other articles:

				W. A. Visser, R. A. Lee, and M. J. M. Gielen Factors Affecting the Distribution of Neural Blockade by Local Anesthetics in Epidural Anesthesia and a Comparison of Lumbar Versus Thoracic Epidural Anesthesia Anesth. Analg., August 1, 2008; 107(2): 708 - 721. [Abstract] [Full Text] [PDF]

				W. A. Visser, M. J. P. G. van Eerd, R. van Seventer, M. J. M. Gielen, J. L. P. Giele, and G. J. Scheffer Continuous Positive Airway Pressure Breathing Increases Cranial Spread of Sensory Blockade After Cervicothoracic Epidural Injection of Lidocaine Anesth. Analg., September 1, 2007; 105(3): 868 - 871. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999