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• W1970956980 abstract "A young, 39-week gestation, primaparous woman requested an epidural for labour analgesia. A dural puncture occurred through the needle at the L3/4 interspace. The epidural catheter failed to pass successfully intrathecally and the attempt was abandoned. A further attempt was made by a different anaesthetist at the L1/2 interspace. Loss of resistance to saline occurred at 7 cm and the epidural catheter was threaded uneventfully. Before securing the catheter, aspiration for blood or cerebrospinal fluid was attempted using a 2-ml syringe and no fluid was aspirated. Two further attempts at aspiration were made and again were negative so a test dose of 10 ml 0.1% bupivacaine and 20 μg fentanyl was given. Two minutes post-dose, the patient had a blood pressure of 69/44 mmHg with a fetal heart rate of 96 bpm. On testing there was reduced ability to straight leg raise and a sensory block to ice cold from S1 to T2 bilaterally. The epidural catheter was aspirated once again and this time 1 ml of clear fluid was easily obtained but on testing for glucose, it came back as negative. However, with signs suggestive of intrathecal catheter placement further aspiration was attempted and a further 1 ml of crystal clear fluid was obtained. This sample tested very strongly for glucose. The catheter was clearly labelled as intrathecal and all subsequent top ups were given by an anaesthetist. Much has been written about testing the fluid aspirated from an epidural catheter [1, 2] and whether or not testing is accurate [3]. We believe that the first sample of fluid aspirated from the catheter was local anaesthetic which had been used as a test dose after insertion. It must be remembered that the dead space of the filter and catheter is about 1 ml and whatever test is used to establish whether the fluid aspirated is cerebrospinal fluid, it is vital that the first 1ml of aspirate is discarded before testing for glucose." @default.
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• W1970956980 date "2009-02-10" @default.
• W1970956980 modified "2023-10-17" @default.
• W1970956980 title "One millilitre could make all the difference!" @default.
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• W1970956980 doi "https://doi.org/10.1111/j.1365-2044.2009.05884.x" @default.
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