Combined lumbar and epidural anesthesia, what does the doctor do behind your back?

In many people’s eyes, anesthesia is an injection, as simple as infusion.
Actually otherwise, such as caesarean section, anorectal surgery is mostly taken half hemp, anesthesia began, the doctor will first order the patient to place the position, that is, the patient’s back like “shrimp” as the bend.
Patients back to the doctor, naturally can not see the anesthesiologist behind what busy!
Let me tell you the secret behind it.

  1. When the patient is placed on his or her side, he or she will feel the anesthesiologist stroking his or her back. In fact, the anesthesiologist is looking for the puncture site and positioning it.
  2. The anesthesiologist then opens the package.
    Put the alcohol, iodine and local anesthetic into the box.
    Some of you may be wondering: Why not open the anesthesia kit before the patient lies on his side?
    Opening the bag first and then positioning it could contaminate it by spreading bacteria through the air flow.
  3. The disinfection.
    First, the anesthesiologist wipes the skin with iodine and then deiodides it twice with alcohol.
    Alcohol needs to be deiodized because it burns the skin for too long.
    Some hospitals only use iodophor for disinfection.
  4. After disinfection, the anesthesiologist lays a sterile towel on the patient and exposes only the puncture site to provide a sterile operation area.
  5. Aspirate local and lumbar anesthetics and perform local anesthesia.
    At this point, the anesthesiologist will first communicate with the patient and administer a local anesthetic at the puncture site.
    So when you do an epidural, you don’t feel pain.
  6. Exit the local hemp needle and expand the skin with a thick needle to facilitate easier entry of epidural needle.
  7. Epidural puncture.
    This is the key point of the puncture. At this point, the anesthesiologist will tell the patient not to move, because once moving, it may cause deviation of the epidural puncture. In severe cases, it may stab the spinal cord, leading to paralysis.
    During the epidural space puncture, the puncture needle passes through the skin – subcutaneous – supraspinous ligament – interspinous ligament – ligamentum flavum – epidural space.
    There is a sense of disappointment when passing through the ligamentum huang, and the epidural cavity presents negative pressure. Glass or low-resistance glass syringe can more keenly perceive this feeling, while pressure syringe can more intuitively judge whether the drug has reached the epidural space through the vesicle.
  8. After the successful epidural puncture, the lumbar anesthesia needle was placed inside the epidural puncture needle to further puncture the dura mater and arachnoid, reaching the subarachnoid space and performing the lumbar anesthesia.
  9. Remove the lumbar hemp needle and insert the epidural catheter into the epidural cavity.
    After successful catheterization, the connector should connect the catheter tip and exit the epidural puncture needle.
  10. The head end of the catheter connector ACTS as a filter to prevent foreign bodies from entering the epidural space.
    After the operation, remove the sterile towel, attach the adhesive tape, fix the catheter, and instruct the patient to lie flat.

The above content is the operation process behind the back of the anesthesiologist after the patient turns sideways. It is not easy to actually implement, let alone complete with one injection as we think!

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