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. 2011 Aug;61(2):138-42.
doi: 10.4097/kjae.2011.61.2.138. Epub 2011 Aug 23.

Effect of airway pressure on lumbar epidural pressure during positive pressure ventilation

Sun Sook Han  1 , Young Jin Lim, Yunseok Jeon, Kyoung-Beom Min, Won-Sik Ahn, Sang Chul Lee
Affiliations

Effect of airway pressure on lumbar epidural pressure during positive pressure ventilation

Sun Sook Han et al. Korean J Anesthesiol. 2011 Aug.

Abstract

Background: The purpose of this study was to measure lumbar epidural pressure (EP) during the insertion of a Tuohy needle under general anesthesia and to evaluate the influence of airway pressure on EP.

Methods: Lumbar EP was measured directly through a Tuohy needle during intermittent positive pressure ventilation in fifteen patients. Mean and peak EP were recorded after peak inspiratory pressures (PIP) of 0, 15, and 25 cmH(2)O.

Results: All measured lumbar EPs were positive, with the pressure increasing during inspiration and decreasing during expiration. Median EP was 6.0 mmHg (interquartile range, 4.0-8.0) at 0 cmH(2)O of PIP, 6.5 mmHg (4.5-8.5) at 15 cmH(2)O, and 8.5 mmHg (6.0-10.5) at 25 cmH(2)O, increasing significantly at 15 cm H(2)O PIP, and further increasing at 25 cmH(2)O (P < 0.001).

Conclusions: We demonstrate the influence of increased airway pressure on lumbar EP measured directly through a Tuohy needle. Lumbar EPs were positive, and increasing PIP levels significantly increased lumbar EP.

Keywords: Epidural pressure; General anesthesia; Lumbar.

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Figures

Fig. 1
Fig. 1
Illustration of a laser leveling device. The zero level of a pressure transducer is set at the insertion point of Tuohy needle.
Fig. 2
Fig. 2
Measurement of epidural pressure at 15 cmH2O of peak inspiratory pressure (PIP). Initial negative pressures are observed in 3 patients (A-C). In the other 12 patients, lumbar EPs are positive following epidural puncture (D).
Fig. 3
Fig. 3
Measurement of epidural pressure at 15, 25, and 0 cmH2O of peak inspiratory pressure (PIP). The large waveform is in phase with positive pressure ventilation, with the pressure increasing during inspiration and decreasing during expiration. The small oscillation waveform is superimposed on a large ventilatory waveform and is synchronous with arterial pulsations.
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