Caesarean delivery in a parturient with a femoro-femoral crossover graft and congenital aortic stenosis repaired by the Ross procedure

Epidural Volume Extension: A Review

“…The MEDLINE database was searched using the keywords: 'epidural volume extension' and 'case reports'; 'combined spinal epidural' and 'lowered intrathecal dose'; and also 'sequential combined spinal epidural'. Data extracted from the full text of the 11 relevant case studies (Table 3) [16][17][18][19][20][21][22][23][24][25][26] included characteristics of the patient, the intrathecal and epidural injections, the sensory block achieved, the occurrence of hypotension and the nature of surgery.…”

“…This is somewhat confusing because the term was first used in the 1980s to describe an approach in which low doses of intrathecal bupivacaine, insufficient to establish surgical anaesthesia, were administered with a much later injection of epidural local anaesthetic to extend the block. To review clinical case reports wherein EVE was used, we included cases in which EVE or sequential CSE was used following a low intrathecal dose (Table 3) [16][17][18][19][20][21][22][23][24][25][26] .…”

Clinical utility of epidural volume extension following reduced intrathecal doses: a randomized controlled trial

“…Thus, there may be a dependence of epidural volume extension on intrathecal dose. What is perplexing is that on the other hand, case reports with successful use of the technique have continued to be published in high-risk patients, following injection of deliberately reduced or sub-optimal intrathecal dose, even as little as 3 mg. 3 , 14 , 15 , 16 Reduction in intrathecal dose was indeed touted as the primary advantage of epidural volume extension, with the sensory level augmentation induced by normal saline being relied upon for adequate block instead.…”