形成单侧硬膜外阻滞的原因.docVIP

Topic of the Day I(for Interns and CA-2’s)Oct 26 - Discuss unilateral epidural block - explain this result形成单侧硬膜外阻滞的原因Discussion point.A unilateral anesthetic block may result from the administration of local anesthetic in the epidural space secondary to the plica mediana dorsalis, a connective tissue band in the epidural space that extends in a vertical direction between the ligamentum flavum and dura mater dividing the epidural space in half. 由于背正中皱襞的存在，在硬膜外腔注入局部麻醉药后可造成单侧阻滞。背正中皱襞作为连接黄韧带和硬膜的带状结缔组织在硬膜外腔垂直延伸，并把其一分为二。Oct 27 - Compare sympathetic, motor sensory block of epidurals vs spinals比较硬膜外麻醉和脊髓麻醉的交感、运动和感觉神经阻滞Discussion points.Epidural anesthesia results in sympathetic nerve blockade, sensory nerve blockade, and motor nerve blockade just as in spinal anesthesia. In epidural anesthesia, however, the levels of each are different than they are in spinal anesthesia. First, sympathetic nerve blockade is at a level equal to sensory nerve blockade, rather than the two to six segments higher that is seen in spinal anesthesia. Second, motor nerve blockade may average four segments lower than sensory nerve blockade, rather than the two segments seen in spinal anesthesia.The major site of action of local anesthetics administered in the epidural space is at the spinal nerve roots. At the spinal nerve roots the dura mater is relatively thin, allowing for the easiest diffusion of local anesthetic through the dura mater to the nerves.There is often a delayed onset in anesthesia at the Sl-S2 nerve root region during an epidural anesthetic. This may be due to the covering of these nerve roots with connective tissue, slowing the diffusion of local anesthetic to these nerve roots.The diffusion of local anesthetic from the epidural space to the subarachnoid space is a minor contributor to the anesthetic effects of local anesthetic solutions in the epidural space. 正如脊髓麻醉一样，硬膜外麻醉亦可阻滞交感、感觉和运动神经。但是，各神经被阻滞的平面在硬膜外麻醉与脊髓麻醉中有所不同。首先，硬膜外麻醉中交感阻滞与感觉阻滞的平面相同，而脊髓麻醉中前者要比后者高2~