Greene Nathaniel H, Cobb Benjamin G, Linnau Ken F, Kent Christopher D
Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA.
Department of Radiology, University of Washington School of Medicine, Seattle, WA 98195, USA.
Anesthesiol Res Pract. 2015;2015:545902. doi: 10.1155/2015/545902. Epub 2015 Jan 1.
Background. Thoracic epidural catheters provide the best quality postoperative pain relief for major abdominal and thoracic surgical procedures, but placement is one of the most challenging procedures in the repertoire of an anesthesiologist. Most patients presenting for a procedure that would benefit from a thoracic epidural catheter have already had high resolution imaging that may be useful to assist placement of a catheter. Methods. This retrospective study used data from 168 patients to examine the association and predictive power of epidural-skin distance (ESD) on computed tomography (CT) to determine loss of resistance depth acquired during epidural placement. Additionally, the ability of anesthesiologists to measure this distance was compared to a radiologist, who specializes in spine imaging. Results. There was a strong association between CT measurement and loss of resistance depth (P < 0.0001); the presence of morbid obesity (BMI > 35) changed this relationship (P = 0.007). The ability of anesthesiologists to make CT measurements was similar to a gold standard radiologist (all individual ICCs > 0.9). Conclusions. Overall, this study supports the examination of a recent CT scan to aid in the placement of a thoracic epidural catheter. Making use of these scans may lead to faster epidural placements, fewer accidental dural punctures, and better epidural blockade.
背景。胸段硬膜外导管可为腹部和胸部大手术提供最佳质量的术后疼痛缓解，但放置是麻醉医生全部技能中最具挑战性的操作之一。大多数接受可能受益于胸段硬膜外导管手术的患者已经进行了高分辨率成像，这可能有助于导管的放置。方法。这项回顾性研究使用了168例患者的数据，以检查计算机断层扫描（CT）上硬膜外-皮肤距离（ESD）与硬膜外放置过程中获得的阻力消失深度之间的关联和预测能力。此外，将麻醉医生测量该距离的能力与专门从事脊柱成像的放射科医生进行了比较。结果。CT测量与阻力消失深度之间存在密切关联（P < 0.0001）；病态肥胖（BMI > 35）的存在改变了这种关系（P = 0.007）。麻醉医生进行CT测量的能力与金标准放射科医生相似（所有个体组内相关系数> 0.9）。结论。总体而言，本研究支持检查近期CT扫描以辅助胸段硬膜外导管的放置。利用这些扫描可能会使硬膜外放置更快，意外硬膜穿刺更少，硬膜外阻滞更好。
