경막외강 내시경술시 생리식염수의 주입 용량에 따른 경추부 경막외강압의 변화

• Published in: Korean journal of anesthesiology Vol. 40; no. 4; pp. 483 - 488
• Main Authors: 오완수, Wan Soo Oh, 손민제, Min Je Son, 위희욱, Hee Wook Wie, 김광민, Kwang Min Kim
• Format: Journal Article
• Language: Korean
• Published: 대한마취통증의학회(구 대한마취과학회) 01-04-2001
• Subjects: cervical epidural pressure; epiduroscopy. Monitoring
• ISSN: 2005-6419; 2005-7563

Background: Normal saline is used to dilate the epidural space to provide a focal length for the lens and to wash the epidural adhesive neural tissue in an epiduroscopy. Saline infusion into the epidural space during an epiduroscopy might affect pressure-volume compliance of the CSF which has a high compliance; therefore, it might cause neurological sequelaes. The purpose of this study was to investigate the change of cervical epidural pressure according to the volume of infused saline during epiduroscopy. Methods: Twenty-one patients who complained of low back pain with radiculopathy that did not respond to conservative pain management and underwent an epiduroscopy were included in this study. The epidural catheter was placed between the 5th and 6th cervical epidural space under fluoroscopic guidance and cervical epidural pressure was monitored. Next, an epiduroscopy via caudal route was performed and cervical epidural pressure was measured after each 10 ml of infused saline. We also checked neurological sequelaes that might be resulted from increased epidural pressure. Results: All patients except two showed no difference in basal cervical epidural pressure. One patient who had failed back surgery syndrome complained of a headache and dizziness when the cervical epidural pressure was rapidly increased from -90mmHg to 5 mmHg following an infusion of 27 ml of saline. One patient who had a herniated disc showed posterior nuchal pain and stiffness following an infusion of 48 ml of saline despite a stable cervical epidural pressure (range: 0-3 mmHg) during the procedure. There were no residual neurological sequelaes in this study. Conclusions: There are variable patterns in cervical epidural pressure according to the volume of infused saline. Close monitoring of intracranial pressure is therefore neccessary during an epiduroscopy. (Korean J Anesthesiol 2001; 40 : 483~488)