Prevention of whole spinal hemp

Prevent rupture of the dura

Epidural block is a blind exploratory puncture, so it is necessary 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 puncture needle and rigid 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 repeat puncture to avoid puncture of the dura. The dural penetration rate of the elderly and children is higher than that of young adults, so be especially careful when piercing. Once the dural is punctured, it is best to switch to another anesthetic method, such as general anesthesia or a nerve block. Spinal anesthesia can be prudently performed if the puncture point is below the waist 2 and the surgical area is the lower abdomen, lower limbs or the anus and perineum.

Application of test dose

It is emphasized to inject the test dose before injecting the full amount of local anesthetics, and observe whether there are signs of spinal anesthesia for 5-10 minutes. If it is necessary to inject the test dose again after changing the position, it 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 started as a normal stage block, and after the second injection, there was spinal anesthesia. The cerebrospinal fluid was extracted through the catheter, indicating that the catheter would also penetrate the dura and enter the subarachnoid space during the maintenance of anesthesia. Difference of symptoms