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Table of Contents
LETTER TO THE EDITOR
Year : 2012  |  Volume : 28  |  Issue : 1  |  Page : 137-138

Use of loss of resistance, to carbon dioxide, in identifying the epidural space


1 Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, USA
2 Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken; Department of Anesthesiology, University of Medicine and Dentistry of New Jersey, Newark, USA

Date of Web Publication31-Jan-2012

Correspondence Address:
G M Atlas
Department of Anesthesiology, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.92475

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How to cite this article:
Junka R A, Chan L, Moises R, Panico E, Hazelwood V, Atlas G M. Use of loss of resistance, to carbon dioxide, in identifying the epidural space. J Anaesthesiol Clin Pharmacol 2012;28:137-8

How to cite this URL:
Junka R A, Chan L, Moises R, Panico E, Hazelwood V, Atlas G M. Use of loss of resistance, to carbon dioxide, in identifying the epidural space. J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2021 May 16];28:137-8. Available from: https://www.joacp.org/text.asp?2012/28/1/137/92475

The use of air, in localizing the epidural space, has been associated with suboptimal or "patchy" anesthesia as well as the rare occurrence of venous and cerebral air emboli. Saline has been documented to be superior and devoid of these side effects. [1],[2] However, saline, being virtually incompressible with respect to air, is significantly more difficult to use for localization of the epidural space.

Carbon dioxide (CO 2 ) would allow for the same ease of localization as air. This occurs as the bulk modulus of CO 2 is almost identical to that of the air. [3],[4] It thus has a similar "feel" when used for identification of the epidural space. CO 2 is also readily absorbed across cell membranes and is more rapidly eliminated, from tissues, than air. [5],[6],[7] Furthermore, CO 2 is actively transported, utilizing carbonic anhydrase, from the cerebral spinal fluid. [8]

A preliminary device has been developed, which allows for CO 2 to be uncomplicatedly administered, through a three-way stopcock, into a traditional glass syringe. This device is illustrated in the [Figure 1].
Figure 1: This device allows for a syringe to be filled, with CO2, to assist in epidural space localization

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Preliminary testing of this technique, on cadaveric bovine spinal sections, has demonstrated that CO 2 may be a reasonable alternative, to both air and saline, for epidural space localization. Further research is necessary to fully assess the potential benefits, and limitations, of this technique.

 
  References Top

1.Beilin Y, Arnold I, Telfeyan C, Bernstein HH, Hossain S. Quality of analgesia when air versus saline is used for identification of the epidural space in the parturient. Region Anesth Pain M 2000;25:596-9.  Back to cited text no. 1
    
2.Shenouda PE, Cunningham BJ. Assessing the superiority of saline versus air for use in the epidural loss of resistance technique: A literature review. Region Anesth Pain M 2003;28:48-53.  Back to cited text no. 2
    
3.Ritter AB, Reisman S, Michniak BB. Biomedical Engineering Principles. Florida CRC: Press Boca Raton; 2005.  Back to cited text no. 3
    
4.Atlas G. The role of bulk modulus in epidural placement. J Anaesth Clin Pharmacol 2010;26:72-3.  Back to cited text no. 4
  [FULLTEXT]  
5.Krogh A. The rate of diffusion of gases through animal tissues, with some remarks on the coefficient of invasion. J Physiol 1919;52:391-408.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Kawashiro T, Nüsse W, Scheid P. Determination of diffusivity of oxygen and carbon dioxide in respiring tissue: Results in rat skeletal muscle. Pflugers Arch 1975;359:231-51.  Back to cited text no. 6
    
7.Kawashiro T, Scheid P. Measurement of Krogh's diffusion constant of CO 2 in respiring muscle at various CO 2 levels: Evidence for facilitated diffusion. Pflugers Arch 1976;362:127-33.  Back to cited text no. 7
[PUBMED]    
8.Siesjo BK. The regulation of cerebrospinal fluid pH. Kidney Int 1972;1:360-74.  Back to cited text no. 8
    


    Figures

  [Figure 1]



 

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