An In Vitro Study of Dural Lesions Produced by 25-Gauge Quincke and Whitacre Needles Evaluated by Scanning Electron Microscopy

Reina, Miguel Ángel; León-Casasola, Óscar A. de; López, Andrés; Andrés, José De; Martin, Sara; Mora, Miguel

doi:10.1097/00115550-200007000-00013

Cited by 79 publications

(49 citation statements)

References 14 publications

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“…There is a small incidence of iatrogenic injury [7][8][9] to the spinal cord after anaesthetic procedures 7 or after acupuncture. 10 These injuries may be either a direct injury during the procedure 8 or delayed presentation due to the migration of a broken needle, 11 but the possibility of self-inflicted injury to the cord using a size 23 G needle is very difficult, due to the well-protected position of the cord in the spinal canal.…”

Section: Discussionmentioning

confidence: 99%

Spinal cord infarction due to a self-inflicted needle stick injury

et al. 2004

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Study design: Case report. Objective: To report a case of spinal cord infarction after a self-inflicted needle stick injury, following an injection of heroin into the cord. Setting: National spinal injury unit in a Scottish University teaching hospital, Glasgow, UK. Case report: A 20-year-old male, injected street heroin accidentally into the cord through the left side of the neck, leading to sudden loss of power to all four limbs. Initial magnetic resonance imaging scans showed extensive cord oedema and follow-up scans showed signal changes within the anterior horns of the spinal cord in keeping with a cord infarct. Conclusion: Self-inflicted spinal cord injury with a small needle is difficult, but not impossible. Cord infarct as a result of a self-inflicted injury has not been previously reported. The mechanism of the injury resulting in cord infarction is explained by the vascular anatomy of the spinal cord circulation, and this may also explain the residual neurological status of the patient.

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Section: Discussionmentioning

confidence: 99%

Spinal cord infarction due to a self-inflicted needle stick injury

et al. 2004

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“…7,9,12 However, at electron microscopy, it has been observed that such needles cause more dural trauma compared with cutting needles. 13 This has been postulated to generate a greater inflammatory response that, in turn, promotes more effective dural repair, thereby reducing CSF leakage.…”

Section: Needle Designmentioning

confidence: 99%

Reducing the incidence of post-dural puncture headache

Waise

Gannon

2013

Clinical Medicine

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-First reported in 1898, post-dural puncture headache (PDPH) remains a significant clinical issue. Here, we present a brief case history and a summary of the current evidence for methods to reduce PDPH rates, along with the experience in our department of implementing these methods in clinical practice. The key points to note are that needle design, gauge and orientation, as well as stylet reinsertion, are factors known to affect the incidence of PDPH, and that there is no evidence to support the use of hydration and bed rest to reduce headache following dural puncture.

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“…The traditional description of collagen fibres running in a longitudinal direction 22 has been disputed by a number of studies of the dura using scanning electron microscopy that indicate that fibres of the dura run in neither a longitudinal direction nor parallel to each other. 23 There is a large amount of variation in the cerebrospinal fluid (CSF) volume of patients. In addition, it has been shown that the volume of CSF in the lumbosacral region varies significantly in obese patients, presumably due to compression of the dura due to inward movement of soft tissue through the intervertebral foramina.…”

Section: Dural Barriermentioning

confidence: 99%

Thoracic Combined Spinal-Epidural (CSE) Anaesthesia

Lee

Zundert

Visser

et al. 2008

Southern African Journal of Anaesthesia and Analgesia

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The experimental delivery of spinal anaesthetics to the desired heights in the body, even above the termination of the spinal cord (thoracic level), has been shown to be potentially very valuable. Since there is no blockade of the lower extremities, little caudal spread, a significantly larger portion of the body experiences no venal dilation, and may offer a compensatory buffer to adverse changes in blood pressure intra-operatively. Further, the dosing of the anaesthetic is exceedingly low, given the highly specific block to only certain nerve function along a section of the cord. Thirdly, the degree of muscle relaxation achievable without central or peripheral respiratory or circulatory depression is superior to that with general anaesthesia.Results from Magnetic Resonance Imaging (MRI) studies indicate that the spinal cord lies anteriorly within its thecal boundaries in the apex of the thoracic curve. Intrathecal injections, therefore, at thoracic levels may have a greater absolute margin of error before needle contact with neural tissue -although the consequences of inadvertent contact are possibly more disastrous.The thoracic CSE technique has been practised in twelve patients with cardiovascular and/or pulmonary problems. Despite bad haemodynamic situations and/or severe end-stage lung problems, abdominal surgery (i.e. cholecystectomy, bowel and vascular surgery) could be performed successfully with the thoracic CSE method, with low impact on the patient. Anaesthetic care of the patients would have been more difficult, with consequently larger impacts on haemodynamic and pulmonary function, should these surgeries have occurred under general anaesthesia -the usual anaesthetic technique of choice.CSE techniques can be used in the thoracic region in patients who otherwise would receive general anaesthesia. High risk patients, with limited cardio-respiratory reserves, present challenges to the anaesthesiologist. Using the thoracic CSE technique in the thoracic space is extending the boundaries of regional anaesthesia.

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An In Vitro Study of Dural Lesions Produced by 25-Gauge Quincke and Whitacre Needles Evaluated by Scanning Electron Microscopy

Cited by 79 publications

References 14 publications

Spinal cord infarction due to a self-inflicted needle stick injury

Spinal cord infarction due to a self-inflicted needle stick injury

Reducing the incidence of post-dural puncture headache

Thoracic Combined Spinal-Epidural (CSE) Anaesthesia

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