Precautions for combined spinal-epidural anesthesia

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Precautions for combined spinal-epidural anesthesia.

Combined spinal-epidural anesthesia: refers to the anesthesia method that combines spinal anesthesia (SA) and epidural anesthesia (EA), which exerts the rapid onset of spinal anesthesia, precise effects, small dosage of local anesthetics and the effectiveness of epidural anesthesia.

The advantages of continuity, easy control of the plane and postoperative pain relief, have been successfully applied to almost all surgical anesthesia and labor analgesia below the lower abdomen.

Precautions for combined spinal-epidural anesthesia

The advantages of continuity, easy control of the plane and postoperative pain relief, have been successfully applied to almost all surgical anesthesia and labor analgesia below the lower abdomen.

Regarding the operation of the puncture technique, a lot has been said in the book, and I will not repeat it here.

The following is mainly based on my own clinical experience and book learning summary to share with you the “alternative” precautions about spinal-epidural puncture.

1. Posture

This is mainly based on the anesthesiologist’s own habits to position the patient, either on the left or right side. Try to make the patient’s back bend and extend the distance between the spinous processes to make the needle easier. Therefore, a good posture is the first step to success.

In addition, communicate with the patient while posing, firstly to relieve the patient’s tension, and secondly, to keep the patient’s posture during the operation to avoid shaking.

2. Open the puncture kit

In order to save trouble, some anesthesiologists grab the edge of the wrapping paper and open it. In fact, this is not right. You should use special sterilizing forceps to open the inside one by one to prevent bacteria from entering the puncture bag with your hands.

In addition, it is best to position the patient first, and then open the puncture bag, because if you open the bag first and then place the position, it may cause bacterial air to flow during the swinging position and contaminate the puncture bag.

3. Draw medicine

When pouring local anesthetics into the bag, some anesthesiologists opened the ampoule and poured it directly.

This is also wrong, because when the ampoule is opened, there will be small broken glass fragments, which will be poured directly into the box.

Many people still use bupivacaine for spinal anaesthetics. I remember that the director told me that if it enters the cerebrospinal fluid, try not to include too many things.

Due to process production problems, we should try to reduce unnecessary steps. I usually use the 3 ml syringe in the puncture bag, install the filter inside, and ask the nurse to open the ampoule for me, and then suck the liquid.

This can reduce the time that the liquid in the ampoule is in contact with the air, and can filter the fallen glass.

4. Disinfection

In order to hurry or save trouble, many doctors disinfect the second time immediately after the first disinfection. In fact, you should wait for the first time to dry, and then perform the second disinfection.

In addition, the disinfected brush should not be placed next to the puncture bag, and should be thrown in the trash can to avoid contaminating other tools in the bag.

5. Needle

The sterile gloves we wear are inevitably stained with talcum powder, so try not to touch the tip of the epidural puncture needle and spinal anesthesia needle during the operation, and avoid bringing talcum powder and other debris into the epidural space and subarachnoid space. .

6. Insert spinal needle after successful epidural puncture

Generally speaking, the human spinal cord ends at L1-L2, so we choose L2-L3/L3-L4 for spinal-epidural puncture without injuring the spinal cord. But in order to prevent cases, we should slowly rotate the spinal needles to avoid damage to the spinal cord due to excessive force.

7. Epidural catheter

For the same reason, we should avoid touching the front end of the epidural catheter, and avoid bringing talcum powder and other debris into the epidural space.

In addition, after the catheterization is completed and the position is restored, the catheter should be tried again. If the medicine cannot be pushed, it is possible that the catheter is crushed.

You can turn over the position to check the catheter and adjust the depth. Avoid passive embarrassment due to the inability to add epidural anesthetics during the operation.

8. Use of filters

Many people ignore the filter in the puncture bag and think it is useless.

At present, most local anesthetics used in anesthesia departments of hospitals are mostly glass injections. After the ampoule is opened, it is inevitable that small glass slag will fall into the local anesthetic. After being injected into the epidural space as a foreign body, granulation will form swollen.

Generally, there is a filter in the spinal-epidural puncture package.

The correct method is to connect the epidural filter after connecting the epidural catheter connector, so as to ensure that the glass slag is not injected into the epidural space.

9. Remember to withdraw

After inserting the epidural catheter, it must be withdrawn immediately to see if there is cerebrospinal fluid and blood.

After lying supine, before injecting the local anesthetic, it is also necessary to withdraw it, as far as possible to ensure that the local anesthetic is not injected into the blood vessel or subarachnoid space.

Although hard joint anesthesia may seem simple, we should be careful in every aspect of it. I hope everyone can share and exchange, provide some valuable experiences and opinions from each other, and learn from each other! thank you all!

Precautions for combined spinal-epidural anesthesia

(sourcechinanet, reference only)

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