A Symptomatic Pneumocephalus as a Complication of Lumbar Epidural Anaesthesia

Introduction: Lumbar epidural anaesthesia is a commonly used technique for analgesia during labour. One of the rare complications of this technique is pneumocephalus. Case description: We report the case of a 35-year-old female admitted to the Emergency Department with severe headache associated with fast head movements. Five days previously she had a eutocic delivery and lumbar epidural anaesthesia was performed. A brain computed tomography (CT) scan showed pneumocephalus and she was admitted to the hospital ward. A brain CT scan on the fourth day of hospitalization showed resolution of ventricular pneumocephalus. Discussion: The most frequently occurring symptom with pneumocephalus is headache associated with fast brain motion resulting from air injection and meningeal irritation. When there is clinical suspicion of pneumocephalus, a brain CT scan should be performed for the diagnosis.

Pain relief in labour: pharmacological

This chapter considers the pharmacological options which a woman may choose to utilize during her labour and birth to help her cope with the pain. Options are described in conjunction with the current evidence base for their effectiveness and recommendations for safe use. They include nitrous oxide and oxygen (Entonox®), pethidine, diamorphine, and lumbar epidural anaesthesia.

Lumbar Epidural space depth has better relations to the Weight than Height of the Patient

This study was carried out on one hundred and fifty male patients undergoing TURP and Cystoscopy under lumbar epidural anaesthesia in urology department mayo hospital with age between 30 years to 100 years with mean 64.29 years, weight 37kg to 96kg with mean 59.21kg and height between 140cm to 187cm with mean 165.34cm. All patients were administered single shot-lumbar epidural anesthesia with tuohy needle no 16 with bupivacain 0.5% volume ranging 15cc to 20cc at level of L3-4 or L4-5 level. Two patients developed lumbar puncture and managed conservatively. The lumbar epidural space ranged between 3.5cm to 6.5cm with mean depth 4.38±0.563. It was concluded statistically that lumbar epidural space depth had better relation to the weight of patients than height.

Cardiovascular effects of lumbar epidural anaesthesia in isoflurane-anaesthetised pigs during surgical removal of the liver

In humans the combined administration of epidural anaesthesia and inhalation anaesthesia may result in cardiovascular instability associated with decreases in heart rate and blood pressure. Anaesthesia was induced with a combination of midazolam / ketamine in 18 female pigs with a mean body weight of 24.9±5.9 kg scheduled for surgical removal of the liver. After tracheal intubation, anaesthesia was maintained on a circle rebreathing circuit with isoflurane. Epidural anaesthesia was administered with ropivacaine (AL-group, n=8) at 0.2 mℓ / kg of a 7.5 mg / mℓ solution to the anaesthetised animals. The A-group (n = 10) received isoflurane anaesthesia only. The vaporiser was set at 2.5 % for the A-group and 1.5 % for the AL-group. Heart rate, invasive systolic, diastolic, and mean arterial blood pressure were monitored. Comparisons were made between treatments and within treatments comparing variables during surgical preparation and abdominal surgery. Differences between treatments were not statistically significant (P > 0.05) during surgical preparation or during abdominal surgery. For within treatment groups, the differences between surgical preparation and abdominal surgery were statistically significant (P < 0.05) for heart rate in the A-group, but not statistically significant (P > 0.05) for the other variables. It is concluded that abdominal surgery may be associated with statistically significant changes in heart rate in isoflurane-anaesthetised pigs and that the combined administration of epidural ropivacaine may prevent statistically significant changes in HR during abdominal surgery.