Prevention of whole-spine anesthesia

Prevent rupture of the dura
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 puncture needle and strong catheter should be discarded. For those who have received multiple epidural blocks, 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 nerve block. Spinal anesthesia can be prudently performed if the puncture point is below the waist and the surgical area is in the lower abdomen, lower limbs or the anal perineal area.
Application of test dose
It is emphasized that the test dose should be injected before the full dose of local anesthetic, and the spinal anesthesia should be observed for 5 to 10 minutes. If the drug needs to be injected again after changing the position, the test dose should be injected again. The first test dose should not be greater than 3~5ml. 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 with a normal stage block, and after re-injection, there is a general spinal anesthesia, and the cerebrospinal fluid is extracted through the catheter, indicating that during the maintenance of anesthesia, the catheter will also penetrate the dura and enter the subarachnoid space. Difference of symptoms