Cauda equina syndrome, a semi-anaesthetic complication that cannot be ignored

Cauda equina syndrome, this complication is unfamiliar to most people, even for some specialist medical staff

Cauda equina syndrome, this complication is unfamiliar to most people, even for some specialist medical staff

The " ponytail " mentioned here is not the tail of a horse, but a spinal ponytail

Next, we look at the concept of cauda equina syndrome:

Next, we look at the concept of cauda equina syndrome:

Cauda equina syndrome is a clinical syndrome characterized by nerve root damage below the level of the medullary cone.

Cauda equina syndrome is a clinical syndrome characterized by nerve root damage below the level of the medullary cone.

Why is the complication of cauda equina syndrome deliberately raised? Is it because the complications are serious?

Answer: No!

Answer: No!

Although a series of complications of cauda equina syndrome are listed above, compared with complications such as paraplegia caused by spinal cord injury, cauda equina syndrome seems to be weaker

Although a series of complications of cauda equina syndrome are listed above, compared with complications such as paraplegia caused by spinal cord injury, cauda equina syndrome seems to be weaker

The answer is revealed: The reason for deliberately proposing cauda equina syndrome is that the location of cauda equina is the most frequently punctured part of the anesthesia method of " half anesthesia " .

How exactly did it hurt?

It can be summarized in three aspects:

It can be summarized in three aspects:

( 1 ) Direct neurotoxicity in the sheath of local anesthetics

( 1 ) Direct neurotoxicity in the sheath of local anesthetics

( 2 ) Compression injury: such as epidural hematoma or abscess

( 2 ) Compression injury: such as epidural hematoma or abscess

( 3 ) Damage to operating factors

( 3 ) Damage to operating factors

So, is it possible for us to completely avoid this kind of damage?

the answer is negative!

the answer is negative!

The reasons are as follows:

The reasons are as follows:

1.

( 1 ) The depth of the catheter for continuous spinal anesthesia into the subarachnoid space should not exceed 4cm, so as not to place the catheter too deep to the tail;

( 2 ) Adopt the minimum local anesthetic dose that can meet the requirements of the operation, and strictly implement the maximum limit of spinal local anesthetics;

( 2 ) Adopt the minimum local anesthetic dose that can meet the requirements of the operation, and strictly implement the maximum limit of spinal local anesthetics;

( 3 ) The lowest effective local anesthetic concentration should be used in spinal anesthesia

( 3 ) The lowest effective local anesthetic concentration should be used in spinal anesthesia

( 4 ) The final concentration of glucose injected into the subarachnoid local anesthetic solution ( 1.

2.
Compression injury, generally seen in epidural hematoma or abscess
.
The formation factors and risk factors of intraspinal hematoma :

⑴Patient factors: advanced age, female, coexisting spinal disease or abnormal coagulation function;

⑴Patient factors: advanced age, female, coexisting spinal disease or abnormal coagulation function;

⑵ Anesthesia factors: the use of thicker puncture needles or catheters, bleeding during puncture or catheterization, continuous spinal canal blocking catheter insertion and removal;

⑵ Anesthesia factors: the use of thicker puncture needles or catheters, bleeding during puncture or catheterization, continuous spinal canal blocking catheter insertion and removal;

⑶ Treatment factors: perioperative anticoagulation and thrombolytic therapy
.

⑶ Treatment factors: perioperative anticoagulation and thrombolytic therapy
.

Because anesthesia puncture target - the epidural space contains a large number of blood vessels , and epidural belongs Blind Detective operation, the anesthesiologist can not see the blood vessels of the epidural space location, so this should be said is difficult to damage Avoid, try to reduce puncture, gently place the tube or reduce the chance
.
On the one hand, the anesthesiologist should pay a detailed visit to the recovery effect of anesthesia.
Once a suspicious hematoma is found, active treatment can reduce the consequences of complications; on the other hand, once the patient finds that the lower limbs are still immobile or abnormally numb after 6 hours after surgery , they need to be contacted in time Medical staff
.

Because anesthesia puncture target - the epidural space contains a large number of blood vessels , and epidural belongs Blind Detective operation, the anesthesiologist can not see the blood vessels of the epidural space location, so this should be said is difficult to damage Avoid, try to reduce puncture, gently place the tube or reduce the chance
.
On the one hand, the anesthesiologist should pay a detailed visit to the recovery effect of anesthesia.
Once a suspicious hematoma is found, actively treat it to reduce the consequences of complications; on the other hand, once the patient finds the blood vessel 6 hours after the operation , the lower extremity is still immobile or abnormally numb, and needs to be promptly Contact medical staff
.

At present, the aseptic operation of medical care has been done very well, and the puncture kits used are all disposable items.
Theoretically, the probability of epidural abscess has been reduced to a very low level, but in recent years there have also been epidurals.
Reports of abscesses
.
Therefore, we should be the main consideration in patients with perioperative immune -related power drops
.
For the prevention and control of epidural abscesses, on the one hand, in addition to strict control in the operation, the production and circulation of the drugs, disinfectants and puncture items used should also be strictly checked; on the other hand, for suspected systemic infections before surgery In addition to life-threatening emergency surgeries, patients should undergo elective surgery after the infection is controlled
.

At present, the aseptic operation of medical care has been done very well, and the puncture kits used are all disposable items.
Theoretically, the probability of epidural abscess has been reduced to a very low level, but in recent years there have also been epidurals.
Reports of abscesses
.
Therefore, we should be the main consideration in patients with perioperative immune -related power drops
.
For the prevention and control of epidural abscesses, on the one hand, in addition to strict control in the operation, the production and circulation of the drugs, disinfectants and puncture items used should also be strictly checked; on the other hand, for suspected systemic infections before surgery In addition to life-threatening emergency surgeries, patients should undergo elective surgery after the infection is controlled
.
Immune infection

3.
Because the epidural puncture is a blind exploration operation, each spinal anatomy is not the same, and the proficiency of anesthesiologists is also different, it is impossible to guarantee 100% success for
each puncture .
Therefore, other than the successful further requested " to reduce the puncture injuries " , in fact anesthesiologist difficult to achieve 100% to avoid damage
.
With the development of visualization technology and the increase in the proportion of patients taking lumbar spine radiographs, anesthesiologists have a relatively well-documented increase in the success rate, but the overall success rate has little effect
.
In addition, I deliberately emphasize that coagulation abnormalities and thrombocytopenia are common in obstetric patients.
The speed of platelet decline before anesthesia is as important as the platelet count.
The progressive decline of platelets indicates a greater risk of intraspinal hematoma
.

3.
Because the epidural puncture is a blind exploration operation, each spinal anatomy is not the same, and the proficiency of anesthesiologists is also different, it is impossible to guarantee 100% success for
each puncture .
Therefore, other than the successful further requested " to reduce the puncture injuries " , in fact anesthesiologist difficult to achieve 100% to avoid damage
.
With the development of visualization technology and the increase in the proportion of patients taking lumbar spine radiographs, anesthesiologists have a relatively well-documented increase in the success rate, but the overall success rate has little effect
.
In addition, I deliberately emphasize that coagulation abnormalities and thrombocytopenia are common in obstetric patients.
The speed of platelet decline before anesthesia is as important as the platelet count.
The progressive decline of platelets indicates a greater risk of intraspinal hematoma
.

Finally, one more verbose sentence: Although most people's medullary conus ends in the lumbar vertebral body 1~2 , there are still a certain percentage of people whose spinal cord does not move up completely
.
Therefore, when performing intraspinal anesthesia, in addition to puncturing the lower lumbar 3-4 vertebral spaces as much as possible , gentle manipulation can also promptly find that the spinal cord has not moved up
.

Finally, one more verbose sentence: Although most people's medullary conus ends in the lumbar vertebral body 1~2 , there are still a certain percentage of people whose spinal cord does not move up completely
.
Therefore, when performing intraspinal anesthesia, in addition to puncturing the lower lumbar 3-4 vertebral spaces as
much as possible , gentle manipulation can also promptly find that the spinal cord has not moved up .


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