BookGiorgio Capogna.
Summary: This book represents a unique and substantial guide, and will bring anesthesiologists up-to-date on advances in the neuraxial technique and its applications in obstetrics. Today the epidural block is almost exclusively of interest to obstetric anesthesiologists, and how it is taught increasingly coincides with its applications in obstetrics. Since the classical, seminal textbooks by Bonica, Moore and Bromage, published in the 1950s and 60s, textbooks devoted solely to the epidural technique have become quite rare. Among more recent books, there are many excellent texts on epidural anesthesia or analgesia in obstetrics, but none are fully dedicated to the epidural technique, which is usually described in a few paragraphs or, at most, in a chapter. This highly detailed book, including videoclip on epidural technique, offers comprehensive coverage on epidurals; as such, it will appeal to all anesthesiologists, especially obstetric anesthesiologists.
Contents:
Intro
Preface
Contents
1: History of Lumbar Epidural Block
1.1 Was the Very First a Spinal or an Epidural Anesthesia?
1.2 The First Epidural Approach: The Caudal
1.3 Lumbar Epidural
1.4 Continuous Lumbar Epidural
1.5 Modern Epidural Analgesia
References
2: Anatomy of the Lumbar Epidural Region
2.1 Vertebral Column
2.2 Lumbar Vertebra
2.3 Ligamentum Flavum
2.4 Interspinous and Supraspinous Ligaments
2.5 Muscles
2.6 Intervertebral Foramen and Its Ligaments
2.7 Epidural Space
2.7.1 Epidural Fat 2.7.2 Nerve Roots and Nerve Root Cuff
2.7.3 Internal Vertebral Venous Plexus, Epidural Arteries, and Lymphatics
2.8 Dural Sac
2.8.1 Dura Mater
2.8.2 Arachnoid Layer
2.8.3 Subdural and Intradural Space
References
3: Distribution of a Solution in the Epidural Space
3.1 Sites of Action, Dynamics of Nerve Block, and Physicochemical Properties of Local Anesthetics
3.2 Local Tissue Distribution
3.3 Absorption and Elimination
3.4 Spread of a Solution in the Epidural Space
3.4.1 Patient Characteristics
3.4.1.1 Age 3.4.1.2 Height, Weight, and Body Mass Index
3.4.1.3 Pregnancy
3.4.2 Technical Factors
3.4.2.1 Needle Insertion Site, Bevel Orientation and Injection Through Needle or Through Catheter, Needle Bevel Direction, and Catheter Position
3.4.2.2 Patient Position
3.4.2.3 Epidural Catheter Design
3.4.2.4 Mode of Administration of the Solution
3.4.2.5 Speed of Injection
3.4.3 Epidural Pressure and Adjacent Pressures
3.4.4 Composition of the Solution Injected: Dose, Volume, and Concentration-Adjuvant Drugs
References
4: Fundamentals
4.1 Epidural Equipment 4.1.1 Epidural Needles
4.1.2 Epidural Syringes
4.1.3 Epidural Devices
4.1.4 Epidural Catheters
4.1.5 Epidural Filters
4.1.6 Connectors
4.2 Patient Position
4.2.1 Positioning the Patient
4.3 Landmarks Identification
4.3.1 Manual Palpation
4.3.2 Ultrasound Identification
4.4 Skin Disinfection
4.5 Superficial Tissues' Local Anesthesia
4.5.1 Technique
References
5: Epidural Technique
5.1 Loss-of-Resistance-to-Saline Technique
5.2 False or Pseudo-Loss of Resistance
5.3 Bone Contact
5.4 Observation and Aspiration of the Needle 5.5 Rebound Test and Partially Inserted Bevel of the Needle in the Epidural Space
5.6 Loss of Resistance to Air
5.7 Techniques Based on Epidural Negative Pressure
5.8 Paramedian Approach
5.9 Forces Involved During Needle Insertion
5.10 Catheter Insertion, Needle Removal, and Catheter Fixation
5.11 Catheter Aspiration and Test Dose
5.12 Confirmation of Catheter Location in the Epidural Space
5.12.1 Epidural Stimulation Test
5.12.2 Epidural Pressure Waveform Analysis
Appendix 1: Epidural Technique in Five Steps