Lumbar Cerebrospinal Fluid Opening Pressure Measured in a Flexed Lateral Decubitus Position in Children

PEDIATRICS ◽  
1994 ◽  
Vol 93 (4) ◽  
pp. 622-623
Author(s):  
Robert Ellis
Keyword(s):  
Cerebrospinal Fluid ◽  
Intrathecal Chemotherapy ◽  
Lateral Decubitus Position ◽  
Normal Range ◽  
Opening Pressure ◽  
Csf Pressure ◽  
Normal Ranges ◽  
Extended Position ◽  
Lateral Decubitus ◽  
Lumbar Cerebrospinal Fluid

Objective. Lumbar punctures in children are generally performed in a flexed position. Published normal ranges for cerebrospinal fluid (CSF) opening pressure require measurement in an extended position, and flexion is known to increase lumbar CSF pressure. This study sought to determine a normal range (mean ± 2 SD) for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children. Methods. Opening pressure was measured in 33 children receiving diagnostic lumbar punctures or prophylactic intrathecal chemotherapy. Measurements were performed in a flexed lateral decubitus position. Patients with medical conditions affecting CSF pressure were excluded. Results. Opening pressure (mean ± SD) was 19.0 ± 4.4 cm H2O. Opening pressure was not significantly affected by patient age or sex. Intrathecal chemotherapy and sedation also did not affect CSF pressure. Conclusions. The normal range for lumbar CSF opening pressure measured in a flexed lateral decubitus position in children is 10 to 28 cm H2O.

How Much Cerebrospinal Fluid Should We Remove Prior to Measuring a Closing Pressure?

2016 ◽  
Vol 32 (4) ◽  
pp. 356-359 ◽  
Author(s):  
Son H. McLaren ◽  
Michael C. Monuteaux ◽  
Atima C. Delaney ◽  
Assaf Landschaft ◽  
Amir A. Kimia
Keyword(s):  
Cerebrospinal Fluid ◽  
Polynomial Regression ◽  
Pressure Change ◽  
Cross Sectional Study ◽  
Inclusion Criteria ◽  
Opening Pressure ◽  
Cross Sectional ◽  
Csf Pressure ◽  
Fractional Polynomial ◽  
Closing Pressure

Objective: The objective of this study was to identify a relationship between cerebrospinal fluid (CSF) volume removal and change in CSF pressure in children with suspected idiopathic intracranial hypertension (IIH). Methods: We performed a cross-sectional study of children 22 years and younger who underwent a lumbar puncture (LP) and had a documented opening pressure, closing pressure, and volume removed. Relationship between volume removal and pressure change was determined using a fractional polynomial regression procedure. Results: In the 297 patients who met the inclusion criteria, CSF pressure decreased by 1 cm H2O for every 0.91 mL of CSF removed if the maximum change in pressure was less than 15 cm H2O ( R2 = 0.38). Conclusion: A linear relationship exists between the volume of CSF removed and the amount of pressure relieved when the desired pressure change is less than 15 cm H2O.

Sevoflurane Increases Lumbar Cerebrospinal Fluid Pressure in Normocapnic Patients Undergoing Transsphenoidal Hypophysectomy 

1999 ◽  
Vol 91 (1) ◽  
pp. 127-130 ◽  
Author(s):  
Pekka Talke ◽  
James E. Caldwell ◽  
Charles A. Richardson
Keyword(s):  
Blood Pressure ◽  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Systolic Blood Pressure ◽  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Csf Pressure ◽  
Sevoflurane Group ◽  
Lumbar Cerebrospinal Fluid

Background The data on the effect of sevoflurane on intracranial pressure in humans are still limited and inconclusive. The authors hypothesized that sevoflurane would increase intracranial pressure as compared to propofoL METHODS: In 20 patients with no evidence of mass effect undergoing transsphenoidal hypophysectomy, anesthesia was induced with intravenous fentanyl and propofol and maintained with 70% nitrous oxide in oxygen and a continuous propofol infusion, 100 microg x kg(-1) x min(-1). The authors assigned patients to two groups randomized to receive only continued propofol infusion (n = 10) or sevoflurane (n = 10) for 20 min. During the 20-min study period, each patient in the sevoflurane group received, in random order, two concentrations (0.5 times the minimum alveolar concentration [MAC] and 1.0 MAC end-tidal) of sevoflurane for 10 min each. The authors continuously monitored lumbar cerebrospinal fluid (CSF) pressure, blood pressure, heart rate, and anesthetic concentrations. Results Lumbar CSF pressure increased by 2+/-2 mmHg (mean+/-SD) with both 0.5 MAC and 1 MAC of sevoflurane. Cerebral perfusion pressure decreased by 11+/-5 mmHg with 0.5 MAC and by 15+/-4 mmHg with 1.0 MAC of sevoflurane. Systolic blood pressure decreased with both concentrations of sevoflurane. To maintain blood pressure within predetermined limits (within+/-20% of baseline value), phenylephrine was administered to 5 of 10 patients in the sevoflurane group (range = 50-300 microg) and no patients in the propofol group. Lumbar CSF pressure, cerebral perfusion pressure, and systolic blood pressure did not change in the propofol group. Conclusions Sevoflurane, at 0.5 and 1.0 MAC, increases lumbar CSF pressure. The changes produced by 1.0 MAC sevoflurane did not differ from those observed in a previous study with 1.0 MAC isoflurane or desflurane.

Desflurane and Isoflurane Increase Lumbar Cerebrospinal Fluid Pressure in Normocapnic Patients Undergoing Transsphenoidal Hypophysectomy

1996 ◽  
Vol 85 (5) ◽  
pp. 999-1004 ◽  
Author(s):  
P. Talke ◽  
J. Caldwell ◽  
B. Dodsont ◽  
C. A. Richardson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Systolic Blood Pressure ◽  
Fluid Pressure ◽  
Random Order ◽  
Mass Effect ◽  
Csf Pressure ◽  
Lumbar Cerebrospinal Fluid

Background Rapid emergence from anesthesia makes desflurane an attractive choice as an anesthetic for patients having neurosurgery. However, the data on the effect of desflurane on intracranial pressure in humans are still limited and inconclusive. The authors hypothesized that isoflurane and desflurane increase intracranial pressure compared with propofol. Methods Anesthesia was induced with intravenous fentanyl and propofol in 30 patients having transsphenoidal hypophysectomy with no evidence of mass effect, and it was maintained with 70% nitrous oxide in oxygen and a continuous 100 micrograms.kg-2.min-1 infusion of propofol. Patients were assigned to three groups randomized to receive only continued propofol infusion (n = 10), desflurane (n = 10), or isoflurane (n = 10) for 20 min. During the 20-min study period, each patient in the desflurane and isoflurane groups received, in random order, two concentrations (0.5 minimum alveolar concentration [MAC] and 1.0 MAC end-tidal) of desflurane or isoflurane for 10 min each. Lumbar cerebrospinal fluid (CSF) pressure, blood pressure, heart rate, and anesthetic concentrations were monitored continuously. Results Lumbar CSF pressure increased significantly in all patients receiving desflurane or isoflurane. Lumbar CSF pressure increased by 5 +/- 3 mmHg at 1-MAC concentrations of desflurane and by 4 +/- 2 mmHg at 1-MAC concentrations of isoflurane. Cerebral perfusion pressure decreased by 12 +/- 10 mmHg at 1-MAC concentrations of desflurane and by 15 +/- 10 mmHg at 1-MAC concentrations of isoflurane. Heart rate increased by 7 +/- 9 bpm with 0.5 MAC desflurane and by 8 +/- 7 bpm with 1.0 MAC desflurane, and by 5 +/- 11 bpm with 1.0 MAC isoflurane. Systolic blood pressure decreased in all but the patients receiving 1.0 MAC desflurane. To maintain blood pressure within predetermined limits, phenylephrine was administered to six of ten patients in the isoflurane group (range, 25 to 600 micrograms), two of ten patients in the desflurane group (range, 200 to 500 micrograms), and in no patients in the propofol group. Lumbar CSF pressure, heart rate, and systolic blood pressure did not change in the propofol group. Conclusion Desflurane and isoflurane, at 0.5 and 1.0 MAC, increase lumbar CSF pressure.

scholarly journals The effect of whole body position on lumbar cerebrospinal fluid opening pressure

2008 ◽  
Vol 5 (1) ◽  
Author(s):  
Pasiri Sithinamsuwan ◽  
Nakorn Sithinamsuwan ◽  
Sirakarn Tejavanija ◽  
Chesda Udommongkol ◽  
Samart Nidhinandana
Keyword(s):  
Cerebrospinal Fluid ◽  
Body Position ◽  
Whole Body ◽  
Opening Pressure ◽  
Lumbar Cerebrospinal Fluid

Body position and cerebrospinal fluid pressure

1976 ◽  
Vol 44 (6) ◽  
pp. 698-705 ◽  
Author(s):  
Bjørn Magnaes
Keyword(s):  
Cerebrospinal Fluid ◽  
Body Position ◽  
Fluid Pressure ◽  
Lateral Position ◽  
Cervical Region ◽  
Content Type ◽  
Csf Pressure ◽  
Neurosurgical Patients ◽  
Csf Leakage ◽  
Lumbar Cerebrospinal Fluid

✓ Lumbar cerebrospinal fluid (CSF) pressure was recorded in 116 adult neurosurgical patients in the lateral and sitting positions. The level of zero CSF pressure while in the sitting position (ZPS) and hydrostatic indifferent point (HIP) for lateral and sitting positions were determined and referred to the craniospinal axis. In control patients ZPS was located mainly at the upper cervical region, and showed nearly the same variation and frequency distribution as CSF pressure in the lateral position when efforts were made to reduce sources of error and there was no orthostatic change in CSF filling pressure. Under these circumstances ZPS may be used as a variable comparable from one subject to another. In control patients the HIP was located between C-6 and T-5. In 25 hydrocephalic patients, shunting resulted in a mean caudal shift of ZPS of 244 mm, and a mean pressure fall of 126 mm H2O in the lateral position. This difference was due to a caudal shift of HIP on shunting. A caudally located ZPS was found in patients with complete cervical subarachnoid block. Prevention and treatment of CSF leakage cranial to HIP is discussed.

Normal cerebrospinal fluid pressure

1974 ◽  
Vol 40 (5) ◽  
pp. 587-593 ◽  
Author(s):  
Olof Gilland ◽  
Wallace W. Tourtellotte ◽  
Lorcan O'Tauma ◽  
William G. Henderson
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Pressure ◽  
Opening Pressure ◽  
Content Type ◽  
Individual Level ◽  
Normal Volunteers ◽  
Csf Pressure ◽  
Average Value ◽  
Young Adult Patient ◽  
The Individual

✓ The authors report studies of cerebrospinal fluid (CSF) pressure in 31 young normal volunteers. In half, a 22-gauge needle was used, and in the other half a 26-gauge needle. The opening CSF pressure was monitored for 10 minutes and also in some during the CSF withdrawal period and the 10-minute CSF reformation period. Cardiac CSF pulse amplitudes and Queckenstedt responses following the opening pressure-monitoring period were also recorded before and after the fluid withdrawal. The average opening pressure was 14.5 cm of 0.15 M sodium chloride (S.D., 3.7) with the 22-gauge needle, and 15.7 cm (S.D., 3.6) in subjects receiving the 26-gauge needle. In each subject the opening pressure tended to fluctuate around a characteristic individual level; in five perfectly relaxed normal volunteers an average value of 20 cm was observed, with a maximal value of 24 cm. The amplitude of the cardiac pulse had a direct relationship to the individual CSF pressure. CSF was withdrawn at two different rates; both withdrawal rates generated approximately linear pressure decay curves. When the withdrawal rates were 5 and 1 ml/min, the average decline of pressure at the end of the period was 9.2 and 5.2 cm respectively. The mean CSF pressures increased only slightly during the 10-minute CSF reformation period. The data obtained should help to define whether a young adult patient does indeed have a CSF pressure elevation.

Surgical Techniques for Thoracoscopic Esophagectomy at the Left Lateral Decubitus Position

2019 ◽  
Vol 70 (2) ◽  
pp. 197-197
Author(s):  
H. Sato ◽  
Y. Miyawaki ◽  
N. Fujiwara ◽  
H. Sugita ◽  
M. Aikawa ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Lateral Decubitus Position ◽  
Thoracoscopic Esophagectomy ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus
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