British Journal of Anaesthesia, 1994, Vol. 73, No. 3 309-314
© 1994 The Board of Management and Trustees of the British Journal of Anaesthesia
research-article |
Positive lumbar extradural space pressure
Department of Anaesthesia, Dudley Road Hospital Birmingham B18 7QH
Specially selected soft Macintosh balloon indicators were attached to needles during five extradural and five spinal punctures. When the needle point entered the extradural space, the mean balloon pressure decreased suddenly from 24.9 (range 14–37) to 12.3 (10–16) mm Hg in the five extradural punctures and from 22.3 (17–28) to 13.7 (10–17) mm Hg in the five spinal punctures. In the five spinal punctures, the balloon pressure did not alter when the needle was advanced from the extradural to the subarachnoid space. Contrary to expectation, none of the balloons deflated when the needle point entered the extradural or subarachnoid spaces. The balloon pressure varied rhythmically in synchrony with respiration and cardiac pulsations. The final balloon pressure, extradural space pressure and subarachnoid pressure were equal. The results suggest that the extradural pressure is positive and of the same magnitude as the prevailing lumbar cerebrospinal fluid pressure. Jugular venous compression, ventilation with carbon dioxide and positive end-expiratory pressure (PEEP) produce a rapid increase in cerebrospinal fluid (CSF) pressure. These stimuli also produced a measurable increase in the lumbar extradural pressure. Jugular venous compression increased the mean lumbar extradural pressure by 6.8 (3–10) mm Hg and ventilation with carbon dioxide increased it by 10 (5–12.5) mm Hg. PEEP values of 5, 10, 15 and 20 cm H2O produced an immediate increase in extradural pressure of 1–2 mm Hg for every 5 cm H2O of PEEP. The lumbar extradural pressure increased rapidly with stimuli known to increase CSF pressure. Changes in spinal CSF pressure may be detected by measuring extradural pressure.