게시판
| 21KS-024 |
Spinal anesthesia of higly obese patients using ultrasound and neelde-through-quincke needle technique
Department of Anesthesiology and Pain Medicine, Gyeongsang National Univ. school of Medicine and Gyeongsang National Univ. Changwon Hospital1, Department of Anesthesiology and Pain Medicine, Gyeongsang National Univ. Hospital2
Introduction
In current, the BMI is constantly increasing, and although not a large number, patients with high BMI often visit the operating room. Spinal anesthesia may be easier if the spinal level is easily identified by palpable spinous processes, but it might be difficult if not palpable.
Case report
A 41 - year - old man(BMI 45.1 kg/m²) was referred for spinal anesthesia for knee surgery. The patient was in right lateral decubitus posture and the depth from the skin to the subarachnoid space was measured about 95 mm, using ultrasound via the parasagittal oblique view. We marked the target line for the insertion point over L3-L4 level.
We punctured the insertion point with the 80 mm 25 G Quincke needle, but there was no CSF leakage. Secondly, the check point was reinserted with an 80 mm 18 G Quincke needle and the depth was set to 80 mm. Then, 120 mm 27 G Whitacre spinal needle was inserted through 18 G needle, and resistance loss and CSF leakage were confirmed. 15 mg bupivacaine with dextrose was injected via 27 G spinal needle. Before removal of the 18 G and 27 G needles, the 18 G needle area of contact with the skin was marked and the two spinal needles were removed all at once. The total depth was measured as 105 mm. Spinal anesthesia was performed without any difficulty and he discharged without any complication after knee surgery.
Conclusion
Non-palpable spinous process and ischium can make troubles in decision of insertion point and direction for spinal anesthesia.
The use of US on the neuroaxis allows the user to check the correct inter-spinous space rather than touching surface anatomical landmarks, to confirm the correct insertion site and direction of the spinal needle, and to predict the DSS. In obese pregnants, the success rates of first spinal anesthesia when US was used or not used US were 92% and 44%, respectively. The use of US will be very helpful in deciding the insertion site and direction of spinal needle.
And, needle-through-quincke needle technique makes it easy the long and thin spinal needle to reach the spinal cannal.
In current, the BMI is constantly increasing, and although not a large number, patients with high BMI often visit the operating room. Spinal anesthesia may be easier if the spinal level is easily identified by palpable spinous processes, but it might be difficult if not palpable.
Case report
A 41 - year - old man(BMI 45.1 kg/m²) was referred for spinal anesthesia for knee surgery. The patient was in right lateral decubitus posture and the depth from the skin to the subarachnoid space was measured about 95 mm, using ultrasound via the parasagittal oblique view. We marked the target line for the insertion point over L3-L4 level.
We punctured the insertion point with the 80 mm 25 G Quincke needle, but there was no CSF leakage. Secondly, the check point was reinserted with an 80 mm 18 G Quincke needle and the depth was set to 80 mm. Then, 120 mm 27 G Whitacre spinal needle was inserted through 18 G needle, and resistance loss and CSF leakage were confirmed. 15 mg bupivacaine with dextrose was injected via 27 G spinal needle. Before removal of the 18 G and 27 G needles, the 18 G needle area of contact with the skin was marked and the two spinal needles were removed all at once. The total depth was measured as 105 mm. Spinal anesthesia was performed without any difficulty and he discharged without any complication after knee surgery.
Conclusion
Non-palpable spinous process and ischium can make troubles in decision of insertion point and direction for spinal anesthesia.
The use of US on the neuroaxis allows the user to check the correct inter-spinous space rather than touching surface anatomical landmarks, to confirm the correct insertion site and direction of the spinal needle, and to predict the DSS. In obese pregnants, the success rates of first spinal anesthesia when US was used or not used US were 92% and 44%, respectively. The use of US will be very helpful in deciding the insertion site and direction of spinal needle.
And, needle-through-quincke needle technique makes it easy the long and thin spinal needle to reach the spinal cannal.
