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Fluid flow through dural puncture sites. An in vitro comparison of needle point types.

Leakage of artificial cerebrospinal fluid through human dura was measured in vitro after puncture by spinal needles. Fluid loss tailed off in all cases and ceased within 5 minutes in 10% of punctures made with a 22-gauge needle, 28% made with a 26-gauge and 65% made with a 29-gauge needle (p less than 0.05). The fluid loss was not reduced by alignment of the level of the needle parallel to the longitudinal direction of the fibres. Whitacre point needles of 22 gauge produced lower fluid loss than a 22-gauge Quincke point needle inserted across the fibres (p less than 0.05). Leakage rate was related to needle size, but not related to the alignment of a Quincke point. Little or no leakage occurred with 29-gauge needles.

Anesthesia, Spinal↗

[Midazolam versus placebo before spinal anesthesia].

The goal of this randomized, double blind and multicentric study was to compare the effects of midazolam (M) and placebo (P) administered by titration before puncture for spinal anaesthesia on the comfort of 211 patients scheduled for elective surgery after oral premedication with hydroxyzine. The administered dose of midazolam was 3.4 +/- 1.3 mg (mean +/- SD). Anxiety was nil in 92% of the patients of the M group and in 64% of the patients of the P group (p < 0.001) and memorization of the pain of the puncture was reported in 34% of the patients of the M group and in 66% of the patients of the P group (p < 0.001). However cooperation of the patient and easiness of the puncture were similar in both groups. In conclusion titrated sedation with midazolam before puncture for spinal anaesthesia increases the comfort of the patient.

Adjuvants, Anesthesia↗