A note on the recording of epidural negative pressure

Usubiaga, Jose E.; Moya, Frank; Usubiaga, Lilia E.

doi:10.1007/bf03003632

Cited by 13 publications

(9 citation statements)

References 3 publications

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“…Visser et al 6 confirmed the pressure gradient in the epidural space by recording the pressure at different levels, finding lower pressures at higher spinal segments. Usubiaca7 also documented this negative pressure gradient by recording simultaneous epidural punctures at different spinal levels, again with lower pressures proximally.…”

Section: Discussionmentioning

confidence: 85%

Lumbar blood patching for proximal CSF leaks: where does the blood go?

et al. 2015

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SUMMARYEpidural blood patching (EBP) is an important therapeutic approach in managing spontaneous cerebrospinal fluid leaks. The mechanism of action of blood patching is likely to be twofold; fluid replacement having an immediate tamponade effect and the proximal flow of blood products having a 'plug' effect. The negative pressure gradient within the epidural space may be important to the rostral flow of injected blood and is possibly increased in intracranial hypotension. BACKGROUND

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Section: Discussionmentioning

confidence: 85%

Lumbar blood patching for proximal CSF leaks: where does the blood go?

et al. 2015

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“…One theory to explain these phenomena is the presence of negative pressure in the epidural space. Usubiaga et al (1967) measured EP in 405 patients at lumbar, while they were in the lateral decubitus position and found negative entry pressures in all of them. However, no mention was made of using a zero reference in that study.…”

Section: Discussionmentioning

confidence: 99%

“…This is supported by some studies (Usubiaga et al 1967), in which epidural pressure (EP) was measured directly by either the loss of resistance or hanging drop methods. However, the belief in the negative pressure of the epidural space is also controversial.…”

Section: Introductionmentioning

confidence: 99%

Full-term pregnant women have higher lumbar epidural pressure than non-pregnant women: A preliminary report

Yang

Lian

et al. 2012

Journal of Obstetrics and Gynaecology

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The objective of this study was to compare the lumbar epidural pressure of full-term pregnant women with that of non-pregnant women. The epidural pressure of 20 full-term pregnant women and 15 non-pregnant women was measured during epidural needle insertion in the lateral position (T0), and at 30-s intervals following insertion (T1-T3), after the patient was turned supine (T4-T6), and after local anaesthetic injection (T7-T9). Results showed that the average epidural pressures following epidural insertion in the lateral position (average of T1-T3), in the supine position (average of T4-T6), and after local anaesthetic injection (average of T7-T9) were all significantly higher in the pregnant women compared with those who were not pregnant (p= 0.0293, 0.0109 and 0.0309, respectively). Epidural pressures increased significantly after women were turned supine (p < 0.001). Average epidural pressures were positive for all time points, T0-T9. It was concluded that the epidural pressure in the pregnant women was higher than in those who were not pregnant, both in the lateral and the supine position.

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“…Usubiaga et al [1] recommended thoracic epidural needle insertion during deep spontaneous inspiration due to decreased EP. Another study used epiduroscopy to show that deep inspiration expanded the thoracic ES and collapsed blood vessels [2].…”

Section: Discussionmentioning

confidence: 99%

“…However, LOR is subjective and thus not always reliable. To improve the success rate of this technique, it has been recommended that the thoracic ES should be accessed during inspiration in patients with spontaneous ventilation, as deep inspiration expands the thoracic ES leading to decreases in epidural pressure (EP) [1,2]. However, positive pressure ventilation may affect EP.…”

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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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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A note on the recording of epidural negative pressure

Cited by 13 publications

References 3 publications

Lumbar blood patching for proximal CSF leaks: where does the blood go?

Lumbar blood patching for proximal CSF leaks: where does the blood go?

Full-term pregnant women have higher lumbar epidural pressure than non-pregnant women: A preliminary report

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

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