CERVICAL EPIDURAL ANAESTHESIA Considerable success has also been observed while offering analgesia to patients having radiculopathy due to osteoarthritis or nonsurgical disc diseases by injecting steroids or local anaesthetics in combination into the
CERVICAL epidural space.
The sympathethic blockade produced by CEA can prevent post herpetic neuralgia if it is offered within first 10-14 days of onset of acute herpes zoster of the head and thorax.
The cervical approach to the epidural space is now becoming common day by day even in the operation threatre.
Simple and reliable monitoring of cerebral function is possible especially during carotid
artery surgery by means of verbal communication with the patient and frequent evaluation of motor strength.
The cervical spinous processes are not angulated and a horizontal approach is indicated.The C7-T1 interspace is the widest and easiest space to use.The ligamentum flavum is very thin and will be reached quite superficially. Agentle “click” may be appreciated while piercing the ligamentum flavum.
At the C6-C7 or C7-T1 level, the epidural space measures 3-4 mm but becomes narrower in the higher segments where the meningeal dura and the endosteal dura fuse at the foramen magnum.Thus the diffusion of the local anaesthetics and narcotics is prevented in the cephalad direction and into the skull protecting the vital centres.
Because of the increased negative
pressure in the thoracic region,volumes of local anaesthetics has a tendency to move downwards and allow thoracic, thyroid, breast and limb surgery if given carefully and in a graded manner.
The thickness of the dura is 2.5mm in the cervical
region as opposed to 0.5mm in the lumbar region.Hence the chances of dural puncture are very rare in the region.
However it is advised that only anaesthetists with considerable experience of lumber epidural block should undertake this procedure.
INDICATIONS OF CERVICAL EPIDURAL ANAESTHESIA This technique should preferably be used in patients belonging to ASA GR. III or IV category having multisystemic disorders of cardiovascular respiratory, endocrine and other systems in various permutations and combinations
We have successfully used CEA for the following surgical procedures:
Surgery on the thyroid dissection.
Breast surgery including radical dissection.
Excision of the anterior chest wall tumour.
Polytrauma involving both the upper extremitites.
Thymectomy in myasthenia gravis.
Upper thoracic spine surgery (in prone position)
Sternal scrapping and post CABG sternal closures.
Brachial artery embolectomy.
Excision of the subclavian aneurysm.
Cervical rib excision and subclavian to brachial artery bypass.
We have recently done CABG under CEA
Nonsurgical indications should include:
Pain:
a. Acute Acute hepes zoster, Raynaud’s disease affection the upper extremities, causalgia from injury to the brachial plexus or its branches.
b. Chronic: Epidural steroid injections for degenerative conditions of the
Cervical spine.
HAMODYNAMIC CHANGES IN HUMANS AFTER THE INDUCTION OF SPINAL ANAESTHESIA ________________________________________________________________________
LOW< T4 HIGH>T4 Mean brachial Arterial pressure Decreased 21% Decreased 44%
Systolic Decreased 50%
Diastolic Decreased43%
Right Auricular pressure Decreased 36% Decreased 53%
Pulmonary artery pressure Decreased 15% Decreased 35%
Cardiac Rate Decreased 8 beats Decreased 10 beats
Stroke Volum Decreased 73 to 68cc Decreased 57 to 43 ml
Minute Output Decreased 16% Decreased 31%
Periphereal resistance Decreased 14% Decreased 18.5%
Calculated left ventricular work Decreased 30% &n
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