(Loco)Regionale Technieken

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Neuraxial Techniques



Spinal and Epidural Block

Ultrasound scanning (US) can offer several advantages when used to guide placement of the needle for centroneuraxial blocks (CNBs). It is noninvasive, safe, simple to use, can be performed expeditiously, provides real-time images, is devoid from adverse effects, and it may be beneficial in patients with abnormal or variant spinal anatomy.
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Spinal Anesthesia

There are absolute and relative contraindications to spinal anesthesia. The only absolute contraindications include patient refusal, infection at the site of injection, hypovolemia, indeterminate neurologic disease, coagulopathy, and increased intracranial pressure, except in cases of pseudotumor cerebri. Relative contraindications include sepsis distinct from the anatomic site of puncture (e.g., chorioamnionitis or lower extremity infection) and unknown duration of surgery. In the latter case, if the patient is on antibiotics and the vital signs are stable, spinal anesthesia may be considered.
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Spinal Anesthesia Continued

The pharmacodynamics of spinal injection of local anesthesia are wide-ranging. The next section reviews the cardiovascular, respiratory, and gastrointestinal consequences of spinal anesthesia. This portion of the chapter focuses on the hepatic and renal effects of spinal anesthesia.
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Caudal Anesthesia

The sacrum is a large triangularly shaped bone formed by the fusion of the five sacral vertebrae. It has a blunted, caudal apex that articulates with the coccyx. Its superior, wide base articulates with the fifth lumbar vertebra at the lumbosacral angle. Its dorsal surface is convex and has a raised interrupted median crest with four (sometimes three) spinous tubercles representing fused sacral spines. Flanking the median crest, the posterior surface is formedby fused laminae. Lateral to the median crest, four pairs of dorsal foramina lead into the sacral canal through intervertebral foraminae, each of which transmits the dorsal ramus of a sacral spinal nerve.
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Caudal Anesthesia Continued

The sacral canal shares in the general engorgement of extradural veins that occurs in late pregnancy, or in any clinical condition in which the inferior vena cava (IVC) is partially obstructed. Since the effective volume of the caudal canal is markedly diminished during the latter part of pregnancy, the caudal dosage should be reduced proportionately in women at term.
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Overzicht van (loco)regionale technieken



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