astromorph injection ? - page 2

I work on a med/surg floor and have a few patients come up with epidurals and require astromorph injections every few hours for pain control. When injecting it, I've heard both that you take a... Read More

  1. by   underdog
    [QUOTE=Mick2003] It's obvious that you've never placed an epidural catheter and, therefore, shouldn't be offering advice on their management. Noone who knows what they are doing would need to inject more than 2 (let alone 7cc) of air when placing an epidural catheter. As below, I refer to an earlier poster who knows what they are talking about..QUOTE]

    Listen up Mickey....Don't tell me when to offer advice and when not to. The O.P. was talking about very small amounts of air that may be obtained when aspirating for CSF or heme. No where did I say that it is okay to inject large amounts of air into the epidural space such as 20cc. Furthermore Mickey, I would venture to say that I have placed more epidurals than you, and I routinely use LOR technique with air and do inject up to 5cc when LOR is obtained. Whadda you know, don't get mom's complaining of a patchy block.
  2. by   mwbeah
    Quote from mick2003
    more than 2-5 cc of air is bad news.
    you are mistaken sir, i have use either air or saline with lor (depends on the syringe in the kit). 2-5 cc of air is benign. i have placed many, many, many epidurals with either air or saline lor technique.

    if it were so dangerous, i don't believe anesthesia and analgesia would have printed this article:

    the median effective dose of intrathecal hyperbaric bupivacaine is larger in the single-shot spinal as compared with the combined spinal-epidural technique

    raymond wee-lip goy, mmed anesthesia, fanzca, yoong chee-seng, mmed anesthesia, fams, alex tiong-heng sia, mmed anesthesia, koay choo-kok, mmed anesthesia, fanzca, fams, and shen liang, msc

    department of anesthesia and intensive care, changi general hospital, singapore
    address correspondence and reprint requests to raymond wee-lip goy, mmed anesthesia, fanzca, department of anesthesia, national university hospital, 5 lower kent ridge rd., singapore 119074. address e-mail to raygoywl@singnet.com.sg . the combined spinal-epidural technique (cse) has been associated with prolonged motor recovery and more frequent arterial hypotension as compared with a single-shot spinal (sss) technique. we determined the median effective dose (med) of intrathecal hyperbaric bupivacaine for cse and sss by using the up-down sequential allocation technique. sixty male patients were randomly allocated to receive intrathecal administration through an sss or cse technique. needle insertion occurred at the l3-4 interspace in all patients. in sss, 9.5 mg of hyperbaric bupivacaine was administered through a 27-gauge whitacre spinal needle. in cse, a 17-gauge tuohy needle with 4 ml of air was used to locate the epidural space, through which a 27-gauge whitacre spinal needle was introduced and 7.0 mg of hyperbaric bupivacaine was administered. the dosing adjustment was 0.5 mg. a "successful" outcome was arbitrarily defined as sensory anesthesia at or above the t6 dermatome lasting for 60 min. a "success" resulted in a 0.5-mg decrement, whereas a "failure" resulted in a 0.5-mg increment in the next patient. there were 13 successes in both groups. the med of bupivacaine was 9.18 mg (95% confidence interval, 8.89-9.47 mg) for cse as compared with 11.37 mg (95% confidence interval, 10.88-11.86 mg) for sss (p < 0.001). cse required 19.3% (95% confidence interval, 14.9%-23.6%) less local anesthetic to achieve the defined clinical target. we found significant discrepancies in the med of hyperbaric bupivacaine between the two techniques. under similar clinical conditions, a 20% decrement in the dose of bupivacaine may be warranted whenever cse is intended in place of sss.

    mike
  3. by   mwbeah
    Quote from Mick2003

    If you reinject air you can cause unblocked segments, or worse, if a lot of air is reinjected (say greater than 20ml) clavicular subq emphasema, (greater than 30ml) severe enough to cause a temporary paraplegia or pneumocephalus, and cranial nerve palsies (Shnider and Levinson Anesthesia for Obstetrics 4th ed page 420)

    think of the epidural space like the pleural space...should be negative, and more than 2-5 cc of air is bad news.
    Either there is an echo in here or zrmorgan and mick are sitting right next to each other, this is exactly what he posted earlier...................

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