Why do patients need to lie on their backs for six to eight hours after an epidural anesthesia?

For anesthetized patients, in order to prevent the residual effect of sedative drugs and muscle relaxation drugs, lying on their back after removing the pillow can better keep the airway unobstructed and effectively prevent the airway obstruction caused by the tongue falling back. Part of the cerebrospinal fluid is lost, the intracranial pressure is higher than the pressure in the spinal cavity, and the cerebrospinal fluid must flow from the intracranial to the spinal cavity. After the operation, the occipital supine position is to remove the gravity factor and cause the cerebrospinal fluid to flow too fast, resulting in low intracranial pressure or even brain herniation.

The need for supine supine after surgery should not be differentiated based on the method of anesthesia. For example, after general anesthesia, if the patient is still lethargic after returning to the ward, he should go to sleep on the pillow. Other nerve block anesthesia includes cervical plexus, brachial plexus block anesthesia, sciatic nerve block, etc. If a sedative drug is used, the patient should also lie down on the occiput if the patient is still drowsy after surgery. This is done in order to avoid the patient's airway obstruction. For the current spinal anesthesia, epidural anesthesia will not cause cerebrospinal fluid leakage, and the current combined spinal and epidural anesthesia will not cause cerebrospinal fluid leakage due to the improvement of the equipment. Such patients do not actually need to go to the pillow if they are awake after surgery. Recumbent. However, at present, the biggest clinical controversy is whether it is necessary to lie on the pillow after epidural anesthesia.

In clinical practice, some anesthesiologists routinely instruct patients to lie on their backs for 4-6 hours even after epidural anesthesia is returned to the ward. Postoperative headache is a common complication of spinal anesthesia. Why does it take 4-6 hours after surgery to remove the occiput? Because after this time, the flow of cerebrospinal fluid between the spinal cavity and intracranial basically returns to the original balance, and the generation of cerebrospinal fluid is to a certain extent. It can also replenish the part of the fluid lost during lumbar puncture, in order to try to avoid headaches caused by low intracranial pressure.

Epidural anesthesia is a method of injecting drugs into the epidural space to produce an anesthetic effect. Since the dura reaches the foramen magnum and fuses with the periosteum on the foramen magnum, the epidural space is in the foramen magnum. The foramen magnum is closed and does not communicate directly with the brain. After conventional anesthetics are injected into the epidural space, it is impossible to directly enter the subarachnoid space, that is to say, it will not affect the volume and pressure of cerebrospinal fluid. Anatomically and physiologically, there will be no complications such as headache and dizziness after epidural anesthesia. disease.

Other situations may be encountered during clinical anesthesia: for example, some patients need to combine intravenous sedation, analgesia, etc. on the basis of epidural anesthesia. , indicating that there is a certain amount of residual intravenous drugs. At this time, the anesthesiologist usually recommends lying on the pillow to ensure good ventilation, and oxygen can be inhaled if necessary; for example, due to intraoperative drug reasons or some special surgical treatment, surgical site and other reasons, the patient will have nausea and vomiting after returning to the ward. , At this time, the anesthesiologist also suggested that the patient lie on the pillow and turn his head to one side as much as possible when vomiting, which is conducive to the outflow of vomit. To prevent aspiration pneumonia or even suffocation.

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