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 Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (8) Citing Articles via Google Scholar Google Scholar Articles by Holst, D. Articles by Wendt, M. Search for Related Content PubMed PubMed Citation Articles by Holst, D. Articles by Wendt, M.

---

REGIONAL ANESTHESIA AND PAIN MANAGEMENT

No Risk of Metal Toxicity in Combined Spinal-Epidural Anesthesia

Dietmar Holst, MD^*, Michael Möllmann, MD, Beate Schymroszcyk, MD, Claudia Ebel, MD^*, and Michael Wendt, MD^*

*Department of Anesthesiology and Intensive Care Medicine, Karlsburg Hospital and Ernst-Moritz-Arndt-University, Greifswald; Department of Anesthesiology and Surgical Intensive Care Medicine, St. Franziskus Hospital; and Department of Anesthesiology and Surgical Intensive Care Medicine, Westfalian Wilhelm's University, Münster, Germany

Address correspondence and reprint requests to Dr. med. Dietmar Holst, Klinik und Poliklinik für Anaesthesiologie und Intensivmedizin, Ernst-Moritz-Arndt-Universität Greifswald, Friedrich-Loeffler-Str. 23 b, D-17489 Greifswald, Germany.

Using the single level needle-through-needle technique for combined spinal-epidural anesthesia (CSE) may introduce very fine metal particles abraded by the spinal needle from the inner ground edge of the Tuohy needle into the patient. Either the local anesthetic administered epidurally or the peridural catheter may also pass intrathecally through the hole in the dura made by the spinal needle. To examine these concerns, the needle-through-needle technique was simulated in an in vitro model (18-gauge Tuohy needle; 27- or 29-gauge Quincke needle). The presence of abraded metal particles was identified by atomic absorption spectrography (AAS). The needles were then examined under an electron microscope. Metal particles could not be identified by using AAS in the needle-through-needle technique after normal clinical use, nor could traces of use be revealed by using an electron microscope to examine the Tuohy needle. With intentionally rough handling and caudal orientation of the spinal needle tip, minimal scratches could be seen by using an electron microscope, but there were no metal particles detected by AAS. In an anatomical preparation, the possible passage of the epidural catheter anesthetic through the dural puncture hole into the cerebrospinal fluid compartment was investigated endoscopically. Neither passage of dyed epidural local anesthetic nor penetration of the epidural catheter into the cerebrospinal fluid compartment could be demonstrated by endoscopy. We conclude that the needle-through-needle-technique is an acceptable way of performing CSE anesthesia. Endangering the patient by an unintentionally intrathecal misplacement of the epidural catheter seems to be very unlikely based on our in vitro model if small spinal needles (27- or 29-gauge) are used.

Implications: Atomic absorption spectrography shows no contamination of the intrathecal compartment by abraded metal particles from the Tuohy needle by combined spinal-epidural anesthesia with the needle-through-needle technique. In vitro, neither passage of dyed epidural local anesthetic nor penetration of the epidural catheter into the cerebrospinal fluid compartment could be demonstrated by endoscopy.

This article has been cited by other articles:

				Y. Sato, W. Zhao, and G. J. Christ Central modulation of the NO/cGMP pathway affects the MPOA-induced intracavernous pressure response Am J Physiol Regulatory Integrative Comp Physiol, July 1, 2001; 281(1): R269 - R278. [Abstract] [Full Text] [PDF]