Prevention of total spinal anesthesia

Epidural block is a blind exploratory puncture, so it is required to be familiar with the anatomy of the spinal canal. The operation should be light and easy. The equipment should be carefully selected, and the unsuitable needle and hard catheter should be discarded. For those who have repeatedly received epidural block, epidural space adhesion or spinal deformity with puncture difficulty, it is not appropriate to repeatedly puncture to avoid piercing the dura. The rate of dural puncture in the elderly and children is higher than that in the young and middle-aged, so puncture should be especially careful. Once the dura is breached, it is advisable to switch to another anesthetic method, such as general anesthesia or nerve block. Spinal anesthesia can be performed prudently if the puncture point is below lumbar 2 and the surgical area is in the lower abdomen, lower limbs, or anal and perineal areas.

Application of test dose

It is emphasized that the test dose should be injected before the full dose of local anesthetic, and the manifestations of spinal anesthesia should be observed for 5-10 minutes. If the drug should be injected again after changing the position, the test dose should also be injected again. The first test dose should not be greater than 3 to 5ml. If the patient is agitated during anesthesia, the catheter may be displaced and inserted into the subarachnoid space. It has been reported that the epidural block starts as a normal stage block, and then the next injection is a total spinal anesthesia, and the cerebrospinal fluid is withdrawn through the catheter, indicating that the catheter can still penetrate the dura into the subarachnoid space during the maintenance of anesthesia. Condition difference

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