Tsui B C, Gupta S, Emery D, Finucane B
Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Walter Mackenzie Health Sciences Centre, Edmonton, Canada.
Can J Anaesth. 2000 May;47(5):471-3. doi: 10.1007/BF03018980.
To report the detection of a subdural catheter placement using nerve stimulation through an epidural catheter.
An 85-yr-old gentleman was scheduled for radical cystectomy and creation of an ileal conduit. Combined general anesthesia and regional technqiue was selected. An epidural catheter (19 G Arrow Flextip Plus) was inserted prior to induction of general anesthesia. Intra-operatively, the patient received 5 mg morphine and 10 ml bupivacane 0.5% via the epidural catheter. The patient remained hemodynamically stable throughout the operation and did not require intravenous opioids. The patient was discharged to the ward with an order for epidural morphine for pain control. The next day, the patient remained comfortable. As an ongoing quality assessment to survey the success rate of epidural catheters at our institution, all patients are invited to have their catheter assessed using an electrical epidural stimulation test. Electrical stimulation (1-10 mA) with a segmental motor response (truncal or extremities movement) indicates that the catheter is in the epidural space. No motor response indicates that it is not. In this case, subdural catheter placement was suspected because a diffuse motor response including right anterior chest wall, back muscle, and bilateral lower extremities was observed using only 0.3 mA. Subdural catheter placement was subsequently confirmed by a radiograph showing a very thin film of dye spreading cephalad and caudad over many segments.
This new electrical test helps to detect subdural placement objectively.
报告通过硬膜外导管利用神经刺激检测硬膜下导管置入情况。
一名85岁男性计划行根治性膀胱切除术并创建回肠代膀胱。选择全身麻醉与区域技术联合应用。在全身麻醉诱导前插入一根硬膜外导管（19G Arrow Flextip Plus）。术中，患者通过硬膜外导管接受了5mg吗啡和10ml 0.5%布比卡因。患者在整个手术过程中血流动力学保持稳定，无需静脉注射阿片类药物。患者出院至病房，医嘱给予硬膜外吗啡用于控制疼痛。第二天，患者仍感觉舒适。作为对我院硬膜外导管成功率进行调查的一项持续质量评估，邀请所有患者使用硬膜外电刺激试验对其导管进行评估。电刺激（1 - 10mA）伴有节段性运动反应（躯干或肢体运动）表明导管位于硬膜外间隙。无运动反应则表明不在。在该病例中，怀疑为硬膜下导管置入，因为仅用0.3mA就观察到包括右前胸壁、背部肌肉和双侧下肢的弥漫性运动反应。随后通过X线片证实为硬膜下导管置入，X线片显示造影剂在多个节段向头端和尾端扩散形成非常薄的一层。
这项新的电测试有助于客观地检测硬膜下置入情况。
