Positive lumbar extradural space pressure

BackgroundThe purpose of this study was to measure lumbar epidural pressure (EP) during the insertion of a Tuohy needle under general anesthesia and to evaluate the influence of airway pressure on EP.MethodsLumbar EP was measured directly through a Tuohy needle during intermittent positive pressure ventilation in fifteen patients. Mean and peak EP were recorded after peak inspiratory pressures (PIP) of 0, 15, and 25 cmH2O.ResultsAll measured lumbar EPs were positive, with the pressure increasing during inspiration and decreasing during expiration. Median EP was 6.0 mmHg (interquartile range, 4.0-8.0) at 0 cmH2O of PIP, 6.5 mmHg (4.5-8.5) at 15 cmH2O, and 8.5 mmHg (6.0-10.5) at 25 cmH2O, increasing significantly at 15 cm H2O PIP, and further increasing at 25 cmH2O (P < 0.001).ConclusionsWe demonstrate the influence of increased airway pressure on lumbar EP measured directly through a Tuohy needle. Lumbar EPs were positive, and increasing PIP levels significantly increased lumbar EP.

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“…EP increased in proportion to the amount of PIP applied. All of the measured lumbar EPs were positive, consistent with previous reports [4,7,8]. …”

Section: Discussionsupporting

confidence: 91%

“…Some authors have reported increases in EP with increasing airway pressure [3,4], whereas others have found airway pressure does not significantly affect EP [5]. However, in these previous studies, EP was measured through the indwelling epidural catheter.…”

Section: Introductionmentioning

confidence: 99%

Effect of airway pressure on lumbar epidural pressure during positive pressure ventilation

Han

Lim

Jeon

et al. 2011

Korean J Anesthesiol

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“…There is less resistance to spread cephalic than caudal and hence solutions introduced into the lumbar epidural space tend to flow upwards rather than downwards 12,13 .Supporting this concept, it can be mentioned the research on the spread of solutions injected into the lumbar epidural space. These studies suggest that the sitting position allowed no actual advantage to patients regarding the blockade of sacral nerves.…”

Section: Resultsmentioning

confidence: 98%

Mechanical properties of the human lumbar dura mater

Zarzur¹

1996

Arq. Neuro-Psiquiatr.

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-Background and objectives: This study aimed to evaluate the transverse and longitudinal distensibility of the posterior human lumbar dura mater. Results are compared with previous literature on biomechanical property studies. Possible clinical implications were also examined. Methods: Samples of human dural sac were obtained from autopsy studies in three adult male cadavers. Dural sac samples were sectioned longitudinally to measure transverse and longitudinal distensibility, thickness and circumference. Results: It was recorded that the posterior lumbar dura mater was easily distensible only in the transverse direction. The longitudinal force required to distend and rupture the posterior lumbar dura mater samples is 3.5 to 6.7 times greater than the force to produce a transversal rupture. Conclusion: Depending on the local cerebrospinal fluid pressure, the documented easier transverse distensibility of the posterior lumbar dura mater may allow greater contact of the lumbar dural sac with the wall of the lumbar verterbral canal. This fact may affect the diffusion of solutions introduced into epidural space.KEY WORDS: dura mater, distensibility thickness, load at rupture, modulus of elasticity, strain at rupture.Little attention has been paid to the elasticity and thickness of the human dura mater. Its elastic property is due to elastic fibers found intermixed with collagen fibers 4 . Collagen fibers are the dominant component found in the human lumbar dura mater 9 . The elastic and collagen fibers are not arranged in an exclusive cephalocaudal direction. It has been shown that both types of fibers are Propriedades mecânicas da dura máter lombar humanaRESUMO -Este estudo procura avaliar as distensibilidades transversal e longitudinal da dura máter lombar na sua porção posterior. Os resultados são comparados com os de outras investigações publicadas sobre as propriedades biomecânicas da dura máter. Métodos: Amostras de dura máter foram obtidas de autópsias realizadas em três cadáveres de homens adultos. As amostras do saco dural foram secionadas longitudinalmente para permitir as seguintes medições: distensibilidade transversal e longitudinal, espessura da dura máter e circunferência do saco dural. Resultados: Foi constatado que a dura máter lombar na sua porção posterior é facilmente distensível. Para distender e romper longitudinalmente esta mesma dura máter, necessita-se de 3,5 a 6,7 vezes mais força do que a necessária para a sua distensão e rompimento na direção transversal. Conclusão: Dependendo da pressão do líquido cefalorraqueano, a fácil distensibilidade transversal da dura máter possibilita maior contato do saco dural lombar com a parede do canal vertebral. Este fato pode influir na difusão das soluções introduzidas no espaço peridural. PALAVRAS-CHAVE: dura máter, distensibilidade, espessura, força para rompimento, módulo de elasticidade.

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“…In these areas the epidural space is empty and the dura mater exerts different degrees of pressure on the canal wall, depending on the local cerebrospinal fluid (CSF) pressure. It has been demonstrated that the lumbar epidural pressure is positive and it bears a clear relationship with the CSF pressure 5,6 . This CSF pressure mantains the dura mater opposed to the vertebral canal wall.…”

Section: Discussionmentioning

confidence: 99%

The shape of the human lumbar vertebral canal

Zarzur

1996

Arq. Neuro-Psiquiatr.

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-Literature on the anatomy of the human vertebral column characterizes the shape of the lumbar vertebral canal as triangular. The purpose of the present study was to determine the precise shape of the lumbar vertebral canal. Ten lumbar vertebral columns of adult male cadavers were dissected. Two transverse sections were performed in the third lumbar vertebra. One section was performed at the level of the lower border of the ligamenta flava, and the other section was performed at the level of the pedicles. The shape of the lumbar vertebral canal at the level of the pedicles tends to be oval or circular, whereas the shape of the lumbar vertebral canal at the level of the lower border of the ligamenta flava is triangular. Thus, the shape of the human lumbar vertebral canal is not exclusively triangular, as reported in the literature. It is related to the level of the transversal section performed on the lumbar vertebra. This finding should be taken into consideration among factors involved in the spread of solutions introduced into the epidural space.KEY WORDS: vertebral column, shape of the lumbar vertebral canal, epidural space. A forma do canal vertebral lombar humanoRESUMO -A literatura sobre a anatomia da coluna vertebral descreve como sendo triangular o formato do canal vertebral na região lombar. O objetivo deste estudo é determinar a real forma do canal da coluna vertebral lombar.Dez colunas vertebrais de cadáveres de homens adultos foram dissecadas. Dois cortes transversais foram executados na terceira vértebra lombar. Um corte foi feito no nível das bordas inferiores de dois ligamentos amarelos vizinhos e o outro corte foi transversal, no nível dos pedículos. A forma do canal vertebral variou: no nível dos pedículos ela tende a ser oval ou circular e junto às bordas inferiores dos ligamentos amarelos passa a ser triangular. Portanto, a forma do canal vertebral lombar não é somente triangular; ela depende do nível em que se faz o corte transversal da vértebra. Estes achados devem ser levados em consideração entre os fatores envolvidos na difusão das soluções introduzidas no espaço peridural. PALAVRAS-CHAVE: coluna vertebral, forma do canal vertebral lombar, espaço epidural.Several literature reports characterize the shape of the human lumbar vertebral canal as being triangular 1,2 ' 7,8 " 10 . This does not seem to be always the case 4,11 . The present study was undertaken with the objective of gaining a better understanding of the anatomy of the human vertebral column and particularly the shape of the lumbar vertebral canal. The purpose of the present study was to determine the precise shape of the lumbar vertebral canal and its relations with the cylindrical dural sac. The findings may add some knowledge about the factors which can affect the diffusion of solutions introduced into the lumbar epidural space.

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Positive lumbar extradural space pressure

Cited by 31 publications

References 12 publications

Effect of airway pressure on lumbar epidural pressure during positive pressure ventilation

Effect of airway pressure on lumbar epidural pressure during positive pressure ventilation

Mechanical properties of the human lumbar dura mater

The shape of the human lumbar vertebral canal

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