Influence of Lumbosacral Cerebrospinal Fluid Density, Velocity, and Volume on Extent and Duration of Plain Bupivacaine Spinal Anesthesia

2004 ◽  
Vol 100 (1) ◽  
pp. 106-114 ◽  
Author(s):  
Hideyuki Higuchi ◽  
Jyun-ichi Hirata ◽  
Yushi Adachi ◽  
Tomiei Kazama
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Spinal Anesthesia ◽  
Onset Time ◽  
Inverse Correlation ◽  
Sensory Block ◽  
Magnetic Resonance Images ◽  
Spinal Block ◽  
Linear Regression Models ◽  
Block Level

Background The current study was designed to investigate the influence of lumbosacral cerebrospinal fluid (CSF) density, velocity, and volume on the extent and duration of plain bupivacaine spinal anesthesia. Methods Forty-one patients scheduled to undergo orthopedic surgery with spinal block were enrolled. Lumbosacral CSF volumes were calculated from low thoracic, lumbar, and sacral axial magnetic resonance images. CSF velocity at the L3-L4 level was derived from phase-contrast magnetic resonance images. Spinal anesthesia was performed in the lateral decubitus position. CSF (2 ml) was sampled to measure CSF density before injection of 3 ml plain bupivacaine (0.5%). Statistical correlation coefficients (rho) between CSF characteristics and measurements of spinal anesthesia were assessed by Spearman rank correlation. In addition, stepwise multiple linear regression models were used to select important predictors of measures of spinal anesthesia. Results There was a significant correlation between CSF density and peak sensory block level (rho = 0.33, P = 0.034). Lumbosacral CSF volume inversely correlated with peak sensory block level (rho = -0.65, P < 0.0001) and positively correlated with onset time of complete motor block (rho = 0.42, P = 0.008). CSF volume also inversely correlated with time required for regression of the sensory block to L1 (rho = -0.35, P = 0.026) and L2 (rho = -0.33, P = 0.039). There was a significant inverse correlation between peak diastolic CSF velocity and duration of motor blockade (rho = -0.44, P = 0.005). Multiple regression analysis revealed that weight and CSF volume significantly contributed to the peak sensory block level (R2 = 0.46). Conclusions These findings indicate that CSF density and volume influence the spread of spinal anesthesia with plain bupivacaine and that CSF volume also influences the duration of spinal anesthesia. CSF velocity might also influence the duration of plain bupivacaine spinal anesthesia.

Cerebrospinal Fluid Density Influences Extent of Plain Bupivacaine Spinal Anesthesia

2002 ◽  
Vol 96 (6) ◽  
pp. 1325-1330 ◽  
Author(s):  
Eduardo Schiffer ◽  
Elisabeth Van Gessel ◽  
Roxane Fournier ◽  
Anne Weber ◽  
Zdravko Gamulin
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Anesthesia ◽  
Inverse Correlation ◽  
Sensory Block ◽  
Spinal Block ◽  
Fluid Density ◽  
Interindividual Variations ◽  
Block Level ◽  
Density Values ◽  
Lateral Decubitus

Background The attempts to explain the unpredictability of extent of spinal block provided by plain local anesthetic solutions have resulted in many clinical reports; however, causes of this uncertainty are as yet unknown. Recently, normal values of the human cerebrospinal fluid densities have been studied showing important interindividual variations, especially between females and males. The current study was designed to evaluate as primary endpoint the influence of cerebrospinal fluid density values on the extent of spinal block with plain bupivacaine. The ancillary endpoints were search of factors explaining the interindividual differences in cerebrospinal fluid density values reported and determination of the relation between upper extent and regression of spinal anesthesia. Methods Sixty-four consecutive patients undergoing peripheral orthopedic surgery with spinal block were enrolled. Spinal anesthesia was performed in the lateral decubitus position with the operated side upward. Two milliliters of cerebrospinal fluid was sampled before injection of 3 ml plain bupivacaine 0.5%. The patient was immediately turned supine and remained in the horizontal position until the end of the study. Maximal sensory block level and time to sensory regression to L4 were determined for each patient enrolled. Cerebrospinal fluid and bupivacaine densities as well as cerebrospinal proteins, glucose, sodium, and chloride concentrations were measured. Results A highly significant correlation between cerebrospinal fluid density and maximal sensory block level was found (P = 0.0004). However, this correlation was poorly predictive (R(2) = 0.37). Cerebrospinal fluid density, proteins, and glucose concentrations were significantly higher in men than in women: 1.000567 +/- 0.000091 versus 1.000501 +/- 0.000109 g/ml (P = 0.014), 0.46 +/- 0.18 versus 0.32 +/- 0.13 g/l (P = 0.001), and 3.27 +/- 0.7 versus 2.93 +/- 0.5 mM (P = 0.023), respectively. A highly significant (P = 0.0004) and predictive (R(2) = 0.73) inverse correlation was found between maximal upper sensory extent and sensory regression to L4. Conclusion These findings indicate an influence of cerebrospinal fluid density on subarachnoid distribution of 3 ml plain bupivacaine 0.5% and show that with higher cerebrospinal fluid densities, a higher spinal block level can be expected.

Factors Affecting the Spread and Duration of Epidural Anesthesia with Ropivacaine

2004 ◽  
Vol 101 (2) ◽  
pp. 451-460 ◽  
Author(s):  
Hideyuki Higuchi ◽  
Yushi Adachi ◽  
Tomiei Kazama
Keyword(s):  
Magnetic Resonance ◽  
Surface Area ◽  
Epidural Anesthesia ◽  
Onset Time ◽  
Sensory Block ◽  
Magnetic Resonance Images ◽  
Venous Plexus ◽  
Block Level ◽  
Epidural Fat ◽  
Fat Volume

Background Epidural anesthesia has an unpredictable extent and duration. Differences in the surface area of the lumbosacral dura, epidural fat volume, and epidural venous plexus velocity might explain the variability in the extent and duration of epidural anesthesia with ropivacaine. Methods Twenty-six healthy patients, aged 18-45 y, undergoing peripheral orthopedic surgery were enrolled. Dural surface area and posterior epidural fat volume were calculated from low thoracic, lumbar, and sacral axial magnetic resonance images obtained at 8-mm increments. Epidural venous plexus velocity at the L3-L4 disk level was derived from phase-contrast magnetic resonance images. The patients received 100 mg ropivacaine (1.0%) epidurally. The spread and duration of sensory anesthesia was assessed by pinprick, and that of motor block was assessed using a modified Bromage scale. Statistical correlation coefficients (rho) between magnetic resonance imaging and epidural anesthesia measurements were assessed by Spearman rank correlation. Stepwise multiple linear regression models were used to select important predictors of measures of epidural anesthesia. Results Dural surface area correlated with peak sensory block level (rho= -0.73, P = 0.0003) and onset time of caudal and cephalad block (rho = 0.62, P = 0.002; rho = -0.63, P = 0.002). Fat volume correlated with the regression to L5-S3 (rho = -0.44.44 to -0.54, P = 0.029 to 0.007). Epidural venous plexus velocity was significantly correlated with the regression to L3 (rho = -0.42, P = 0.038) and L4 (rho = -0.48, P = 0.017). Multiple regression analysis revealed that dural surface area was a significant predictive variable for the peak sensory block level (R = 0.61, P < 0.0001). Conclusions These findings indicate that dural surface area influences the spread of epidural anesthesia with ropivacaine and posterior fat volume influences the duration of epidural anesthesia in healthy patients within a narrow age range. Epidural venous plexus velocity might also influence the duration of epidural anesthesia with ropivacaine.

scholarly journals The effect of height and weight adjusted dose of intrathecal hyperbaric bupivacaine for elective caesarean section

2011 ◽  
Vol 51 (181) ◽  
Author(s):  
A Subedi ◽  
M Tripathi ◽  
BK Bhattarai ◽  
PK Gupta ◽  
K Pokharel ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Elective Caesarean Section ◽  
Onset Time ◽  
Distinct Advantage ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Number Of Patients ◽  
Block Level ◽  
Adjusted Dose

Introduction: The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fi xed dose during caesarean section. Methods: A hundred parturients, who had given their consent and were scheduled for elective caesarean section under spinal anesthesia, were randomly assigned into two groups. We adjusted the intrathecal dose of heavy bupivacaine (0.5 %) according to the height and weight of patients (Group AD) from Harten’s dose chart developed from the Caucasian parturients and the fi xed dose (2.2 ml) was used in Group FD patients. Keeping the observer blinded to the study groups, the onset time to sensory block up to T5, haemodynamic changes, side effects, and fetal outcome were observed. Results: The median onset time of spinal block in Group FD was faster than in Group AD (6 min vs. 4 min; p = 0.01). The spinal block level extended above T3 level in a signifi cantly (p < 0.05) larger number of patients 12 (24 %) in Group FD than in one (2 %) patient in Group AD. A signifi cantly (p < 0.05) larger number of patients, 32, (64 %) in Group FD had hypotension than in 15 (30 %) patients in Group AD. The lowest recorded SAP (101 ± 6 mm Hg) in Group AD was higher than in Group FD (96 ± 6.7 mm Hg). Nausea and vomiting were more pronounced in Group FD patients. Conclusions: The bupivacaine dose was signifi cantly reduced on its dose adjustment for the body weight and height of patients for cesearean section. This adjusted-dose use suitably restricted spinal block level for cesarean section with a distinct advantage of less hypotension and with a similar neonatal outcome as fi xed compared with the dose use. keywords: caesarean section; low-dose hyperbaric bupivacaine; spinal anesthesia.

Lumbosacral Cerebrospinal Fluid Volume Is the Primary Determinant of Sensory Block Extent and Duration during Spinal Anesthesia 

1998 ◽  
Vol 89 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Randall L. Carpenter ◽  
Quinn H. Hogan ◽  
Spencer S. Liu ◽  
Bert Crane ◽  
James Moore
Keyword(s):  
Cerebrospinal Fluid ◽  
Electrical Stimulation ◽  
Spinal Anesthesia ◽  
Rank Correlation ◽  
Sensory Block ◽  
Magnetic Resonance Images ◽  
Motor Blockade ◽  
Transcutaneous Electrical Stimulation ◽  
Kendall Rank Correlation ◽  
Primary Determinant

Unlabelled BACKGROUND. Injection of local anesthetic into cerebrospinal fluid (CSF) produces anesthesia of unpredictable extent and duration. Although many factors have been identified that affect the extent of spinal anesthesia, correlations are relatively poor and the extent of spread remains unpredictable. This study was designed to determine whether variability in the volume of lumbosacral CSF among individuals is a contributing factor in the variability of spinal anesthesia. Methods Spinal anesthesia was administered to 10 healthy volunteers with 50 mg lidocaine in 7.5% dextrose. The technique was standardized to minimize variability in factors known to affect the distribution of spinal anesthesia. The extent of sensory anesthesia was assessed by pin-prick and by transcutaneous electrical stimulation. Motor blockade was assessed in the quadriceps and gastrocnemius muscles by force dynamometry. Duration of anesthesia was assessed by pinprick, transcutaneous electrical stimulation, and duration of motor blockade. Lumbosacral CSF volumes were calculated from low thoracic, lumbar, and sacral axial magnetic resonance images obtained at 8-mm increments. Volumes of CSF were correlated with measures of extent and duration of spinal anesthesia using the Kendall rank correlation test. Results Lumbosacral CSF volumes ranged from 42.7 to 81.1 ml. Volumes of CSF correlated with pin-prick assessments of peak sensory block height (P = 0.02) and duration of surgical anesthesia (as assessed by the duration of tolerance to transcutaneous electrical stimulation at the ankle (P &lt; 0.05). Conclusions Variability in lumbosacral CSF volume is the most important factor identified to date that contributes to the variability in the spread of spinal sensory anesthesia.

Acute reduction of cerebrospinal fluid volume prior to spinal anesthesia: implications for sensory block extent

2020 ◽  
Vol 86 (6) ◽  
Author(s):  
Martin F. Bjurström ◽  
Niklas Mattsson ◽  
Andreas Harsten ◽  
Nicholas Dietz ◽  
Mikael Bodelsson
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Anesthesia ◽  
Sensory Block ◽  
Fluid Volume ◽  
Cerebrospinal Fluid Volume

Non-inflammation cerebrospinal fluid and normal brain magnetic resonance images of Autoimmune encephalits

2019 ◽  
Author(s):  
Yake Zheng ◽  
Peng Zhao ◽  
yajun lian ◽  
Lihao Li ◽  
Yuan Chen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Clinical Symptoms ◽  
Brain Mri ◽  
Clinical Manifestations ◽  
Speech Disorders ◽  
Magnetic Resonance Images ◽  
Normal Brain ◽  
Recurrence Rates ◽  
Clinical Prognosis

Abstract Background We set out to investigate the characteristics and factors related to non-inflammation cerebrospinal fluid (CSF) and normal brain magnetic resonance images (MRI) of autoimmune encephalitis (AE) in patients. Methods The distribution and characteristics of brain MRI and CSF in 124 patients who were living with anti-NMDAR(71), LGI1(26),CASPR2(4),GABAR(23) encephalitis and who had been admitted between October 2016 and May 2018 were analyzed prospectively. Results 12 of the 124 patients(1%) had a normal MRI and non-inflammation CSF.Ten of them were LGI1(83%),while the remaining 1 patient was NMDAR(8.3%),1 patient was CASPR2(8.3%).The clinical symptoms including epilepsy, psychosis, cognitive disorders, conscious disorders, headache, faciobrachial dystonic seizure (FBDS), speech disorders and hypoventilation. AE with non-inflammation CSF and normal MRI with good clinical prognosis. The median modified Rankin Scale (mRS) was low, and recurrence rate was also low. Conclusion The clinical manifestations of on-inflammation CSF and brain MRI-negative patients with AE are not specific, but suggest a better prognosis and a lower recurrence rates.

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