tailieunhanh - How to Survive in Anaesthesia - Part 7

Vô sinh của các bác sĩ gây mê này không đề cập đến khả năng sinh sản của họ, nhưng có nghĩa là mặc một áo choàng, mặt nạ, mũ, găng tay. tê ngoài màng cứng Các không gian ngoài màng cứng chạy từ cơ sở của hộp sọ để dưới cùng của xương cùng ở màng sacrococcygeal. Tủy sống, dịch não tủy, và màng não được đính kèm bên trong nó (hình 20,1). | emedicina How to Survive in Anaesthesia Sterility of the anaesthetist does not refer to their reproductive capacity but means wearing a gown mask hat and gloves. Epidural anaesthesia The epidural space runs from the base of the skull to the bottom of the sacrum at the sacrococcygeal membrane. The spinal cord cerebrospinal fluid and meninges are enclosed within it Figure . Skin Subcutaneous tissue Supraspinous ligament Interspinous ligament Ligamentum flavum Synovial fold Epidural space Longitudinal venous sinus Hyaline plate Annulus fibrosus Figure Anatomy of the epidural space. The spinal cord becomes the cauda equina at the level of L2 in an adult and the cerebrospinal fluid stops at the level of S2. The epidural space is between 3-6 mm wide and is defined posteriorly by the ligamentum flavum the anterior surfaces of the vertebral laminae and the articular processes. Anteriorly it is related to the posterior longitudinal ligament and laterally is bounded by the intervertebral foramenae and the pedicles. The contents of the epidural space are nerve roots venous plexus 110 emedicina Regional anaesthesia fat lymphatics. The veins contain no valves and communicate directly with the intracranial thoracic and abdominal venous systems. Box Absolute and relative contraindications to epidural anaesthesia Absolute patient refusal abnormal clotting infection - local on back septicaemia allergy to local anaesthetic drug Relative raised intracranial pressure hypovolaemia chronic spinal disorders central ner vous system disease drugs - aspirin other NSAIDs low dose heparin Contraindications to epidural anaesthesia are shown in Box . Abnormal clotting may result in haemorrhage in a confined space if an epidural vein is punctured during the insertion of an epidural cannula. An epidural haematoma then causes spinal cord compression. Local skin infection may introduce bacteria into the spinal meninges with the risk of an abscess or meningitis. Similarly in .