Epidural administration - Knowledge (XXG)

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oral analgesia or no analgesia has no effect on the normal length of hospital stay after childbirth, the only difference being that care must be performed around the epidural insertion site to prevent infection. Following epidural analgesia used for gastrointestinal surgery, the time to recovery of normal gastrointestinal function is not significantly different from recovery time after intravenous analgesia. The use of epidural analgesia during cardiac surgeries may shorten the amount of time a person requires ventilator support following surgery, but it is unknown whether it shortens the overall post-surgery hospital stay overall.

479:. For this reason, adequate pain control can usually be attained without blocking the motor neurons, which would cause a loss of muscle control if it occurred. Depending on the drug and dose administered, the effects may last only a few minutes or up to several hours. As such, an epidural can provide pain control without as much of an effect on muscle strength. For example, a woman in labor who is being administered continuous analgesia via an epidural may not have impairment to her ability to move. Larger doses of medication are more likely to result in side effects. Very large doses of some medications can cause paralysis of the 5616: 512:. The epidural catheter may also rarely be inadvertently placed in the subarachnoid space, which occurs in less than 1 in 1000 procedures. If this occurs, cerebrospinal fluid can be freely aspirated from the catheter, and this is used to detect misplacement. When this occurs, the catheter is withdrawn and replaced elsewhere, though occasionally no fluid may be aspirated despite a dural puncture. If dural puncture is not recognized, large doses of anesthetic may be delivered directly into the cerebrospinal fluid. This may result in a high block, or, more rarely, a 5250: 5723: 5115: 414:. The risk of complications from steroid administration is low and complications are usually minor. The specific drug, dose, and frequency of administration impacts the risk for and severity of complications. Complications of epidural steroid administration are similar to the side effects of steroids administered in other manners, and can include higher than normal blood sugar, especially in patients with 5963: 5244: 5125: 598: 845:. Corning inadvertently injected 111 mg of cocaine into the epidural space of a healthy male volunteer, although at the time he believed he was injecting it into the subarachnoid space. Following this, in 1901 Fernand Cathelin first reported intentionally blocking the lowest sacral and coccygeal nerves through the epidural space by injecting local anesthetic through the 5785: 883:

as race, financial stability, and education influence the rate at which women receive epidural analgesia. One survey in 2014 found that over half of pregnant women in a Nigerian antenatal clinic (79.5%) did not know what epidural analgesia was or what it was used for, while 76.5% of them would utilize epidural analgesia if offered after it was explained to them.

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significant effect on the necessity to perform a cesarean delivery. A 2018 Cochrane review found no increase in the rate of Caesarean delivery when epidural analgesia was employed. However, epidural analgesia does lengthen the second stage of labor by 15 to 30 minutes, which may increase the risk a delivery must be assisted by instruments.

55: 738:(moving X-ray pictures). After placement of the tip of the needle, a catheter or small tube is threaded through the needle into the epidural space. The needle is then withdrawn over the catheter. The catheter is generally inserted 4–6 cm into the epidural space, and is typically secured to the skin with adhesive tape, similar to an 338:

long-term backache was unchanged after epidural use. Complications of epidural analgesia are rare, but may include headaches, dizziness, difficulty breathing and seizures for the mother. The child may experience a slow heartbeat, decreased ability to regulate temperature, and potential exposure to the drugs administered to the mother.

5489: 572:, loss of consciousness, respiratory depression and apnea. Bupivacaine intended for epidural administration has been implicated in cardiac arrests resulting in death when accidentally administered into a vein instead of the epidural space. The administration of large doses of opioids into the epidural space may cause 504:

months, and is caused by a reduction in CSF pressure. Mild post-dural-puncture headaches may be treated with caffeine and gabapentin, while severe headaches may be treated with an epidural blood patch, though most cases resolve spontaneously with time. Less common but more severe complications include

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In some developed countries, over 70% of childbirths involve epidural analgesia. Other studies have shown that minority women and immigrants are less likely to receive epidural analgesia during childbirth. Even in countries with universal healthcare coverage such as Canada, socioeconomic factors such

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oxytocin and prolactin levels in response to breastfeeding on the second day following birth. The lower maternal oxytocin level negatively affects the baby’s feeding rooting reflex, decreasing the amount of milk produced. The consequence of these effects from epidural analgesia is higher weight loss.

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described using a continuous epidural catheter for pain relief during childbirth. In 1941, Robert Hingson and Waldo Edwards recorded the use of continuous caudal anesthesia using an indwelling needle, following which they described the use of a flexible catheter for continuous caudal anesthesia in a

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or air may be used to identify placement in the epidural space. A systematic review from 2014 showed no difference in terms of safety or efficacy between the use of saline and air for this purpose. In addition to the loss of resistance technique, direct imaging of the placement may be used. This may

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to confirm correct placement. Once placed, medication may be administered in one or more single doses, or may be continually infused over a period of time. When placed properly, an epidural catheter may remain inserted for several days, but is usually removed when it is possible to use less invasive

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conditions of the spinal cord. It is not recommended for people with severe bleeding disorders, low platelet counts, or infections near the intended injection site. Severe complications from epidural administration are rare, but can include problems resulting from improper administration, as well as

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Epidural analgesia is generally well tolerated, with recovery time quick after administration is complete and the epidural is removed. The epidural catheter is usually removed when it is possible to safely switch to oral administration of medications, though catheters can safely remain in place for

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In many women given epidural analgesia during labor oxytocin is also used to augment uterine contractions. In one study which examined the rate of breastfeeding two days following epidural anesthesia during childbirth, epidural analgesia used in combination with oxytocin resulted in lower maternal

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The use of epidural analgesia during a birth does not have any effect on whether a caesarean section must be performed during future births. Epidural analgesia during childbirth also generally has no negative effects on the long-term health of the mother or child. Use of epidural analgesia versus

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may be administered. Thereafter, this bolus may be repeated if necessary provided the catheter remains undisturbed. For a prolonged effect, a continuous infusion of medication may be used. There is some evidence that an automated intermittent bolus technique may provide better pain control than a

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If the dura is accidentally punctured during administration, it may cause cerebrospinal fluid to leak into the epidural space, causing a post-dural-puncture headache. This occurs in approximately 1 in 100 epidural procedures. Such a headache may be severe and last several days, or rarely weeks to

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solution. Subcutaneously tunneled epidural catheters may be safely left in place for longer periods, with a low risk of infection or other complications. Regardless of the length of use, the effects of a medicine administered epidurally, including numbness if used for analgesia, usually wear off

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Epidural administrations can also cause bleeding issues, including "bloody tap", which occurs in approximately 1 in 30–50 people. This occurs when epidural veins are inadvertently punctured with the needle during the insertion. It is a common occurrence and is not usually considered a problem in

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or "horse's tail". Hence, lumbar epidural injections carry a low risk of injuring the spinal cord. Insertion of an epidural needle involves threading a needle between the bones, through the ligaments and into the epidural space without puncturing the layer immediately below containing CSF under

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Some people continue to be concerned that women who are administered epidural analgesia during labor are more likely to require a cesarean delivery, based on older observational studies. However, evidence has shown that the use of epidural analgesia during labor does not have any statistically

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However, the review found no difference in overall Caesarean delivery rates between epidural analgesia versus no analgesia. Additionally, there was no difference found on the immediate neonatal health of the child between epidural analgesia versus no analgesia. Furthermore, the occurrence of

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of the newborn between early and late epidural administration. Epidurals other than low-dose ambulatory epidurals also impact the ability of the mother to move during labor. Movement such as walking or changing positions may help improve labor comfort and decrease the risk of complications.

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consists of a small amount of a person's own blood is injected into the epidural space. This is done as a method of sealing a hole or leak in the epidural. The injected blood clots at the site of the puncture, closes the leak, and modulates CSF pressure. This may be used to treat

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Jonas K, Johansson LM, Nissen E, Ejdebäck M, Ransjö-Arvidson AB, Uvnäs-Moberg K (2009). "Effects of Intrapartum Oxytocin Administration and Epidural Analgesia on the Concentration of Plasma Oxytocin and Prolactin, in Response to Suckling During the Second Day Postpartum".

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Caffeine proved to be effective in decreasing the number of people with PDPH and those requiring extra drugs (2 or 3 in 10 with caffeine compared to 9 in 10 with placebo). Gabapentin, theophylline and hydrocortisone also proved to be effective, relieving pain better than

793:. The spinal dose is then given, the spinal needle withdrawn, and the epidural catheter inserted as normal. This method, known as the "needle-through-needle" technique, may be associated with a slightly higher risk of placing the catheter into the subarachnoid space. 849:. The loss of resistance technique was first described by Achile Dogliotti in 1933, following which Alberto Gutiérrez described the hanging drop technique. Both techniques are now used to identify when the needle has correctly been placed in the epidural space. 670:, which contains the cerebrospinal fluid. In adults, the spinal cord terminates around the level of the disc between L1 and L2, while in neonates it extends to L3 but can reach as low as L4. Below the spinal cord there is a bundle of nerves known as the 3430:

Shi WZ, Miao YL, Yakoob MY, Cao JB, Zhang H, Jiang YG, Xu LH, Mi WD (September 2014). "Recovery of gastrointestinal function with thoracic epidural vs. systemic analgesia following gastrointestinal surgery: Analgesia and gastrointestinal function".

789:(CSE). The spinal anesthetic may be administered in one location, and the epidural at an adjacent location. Alternatively, after locating the epidural space with the Tuohy needle, a spinal needle may be inserted through the Tuohy needle into the 371:

which would occur with systemic opioid therapy through blockade of the sympathetic nervous system. Some surgeries that spinal analgesia may be used in include lower abdominal surgery, lower limb surgery, cardiac surgery, and perineal surgery.

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If bupivacaine, a medication commonly administered via epidural, is inadvertently administered into a vein, it can cause excitation, nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision, or seizures as well as

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Epidural analgesia has been demonstrated to have several benefits after other surgeries, including decreasing the need for the use of oral or systemic opioids, and reducing the risk of postoperative respiratory problems, chest infections,

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for all women during childbirth since 1980. By 1998, epidural analgesia was used in the UK for almost 25% of childbirths. In Japan, most childbirths take place in primary or secondary hospitals in which epidural analgesia is not offered.

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affected, and thus the area of the body from which pain will be blocked. Insertion of an epidural catheter consists of threading a needle between bones and ligaments to reach the epidural space without going so far as to puncture the

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The person receiving the epidural may be seated, or lying on their side or stomach. The level of the spine at which the catheter is placed depends mainly on the site of intended operation – based on the location of the pain. The

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In the United States in 1998, it was reported that over half of childbirths involved the use of epidural analgesia, and by 2008 this had increased to 61% of births. In the United Kingdom, epidurals have been offered through the

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Along with a sudden loss of resistance to pressure on the plunger of the syringe, a slight clicking sensation may be felt by the operator as the tip of the needle breaches the ligamentum flavum and enters the epidural space.

2546:"Epidural Analgesia With or Without Oxytocin, but Not Oxytocin Alone, Administered During Birth Disturbs Infant Pre-feeding and Sucking Behaviors and Maternal Oxytocin Levels in Connection With a Breastfeed Two Days Later" 692:

Epidural administration is a procedure which requires the person performing the insertion to be technically proficient in order to avoid complications. Proficiency may be trained using bananas or other fruits as a model.

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Simulation of the insertion of an epidural needle between the spinous processes of the lumbar vertebrae. A syringe is connected to the epidural needle and the epidural space is identified by a technique to assess loss of

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responsible for breathing, which may lead to respiratory depression or arrest. It may also result in loss of sympathetic nerve input to the heart, which may cause a significant decrease in heart rate and blood pressure.

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Nagel SJ, Reddy CG, Frizon LA, Holland MT, Machado AG, Gillies GT, Howard MA (October 2018). "Intrathecal Therapeutics: Device Design, Access Methods, and Complication Mitigation: INTRATHECAL THERAPEUTICS REVIEW".

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into the epidural space, which may remain in place for the duration of the treatment. The technique of intentional epidural administration of medication was first described in 1921 by Spanish military surgeon

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and respiratory depression. The sensation of needing to urinate is often significantly diminished or completely absent after administration of epidural local anesthetics or opioids. Because of this, a

5055: 4866: 856:, a military surgeon from Spain, developed the technique of "single-shot" lumbar epidural anesthesia, which was later popularized by Italian surgeon Achille Mario Dogliotti. Later, in 1931 5070: 559:. Rarely, an epidural may cause death (1 in 100,000). In circumstances where contraindications exist, there are numerous fascial plane blocks that may be provided instead of an epidural. 237:, and inadequate pain control. Epidural analgesia during childbirth may also impact the mother's ability to move during labor. Very large doses of anesthetics or analgesics may result in 3158:

Kostopanagiotou G, Kyroudi S, Panidis D, Relia P, Danalatos A, Smyrniotis V, Pourgiezi T, Kouskouni E, Voros D (2002). "Epidural catheter colonization is not associated with infection".

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Liu N, Wen SW, Manual DG, Katherine W, Bottomley J, Walker MC (March 2010). "Social disparity and the use of intrapartum epidural analgesia in a publicly funded health care system".

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Patel SS, Dunn CJ, Bryson HM (1996). "Epidural clonidine: a review of its pharmacology and efficacy in the management of pain during labour and postoperative and intractable pain".

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woman in labor in 1942. In 1947, Manuel Curbelo described placement of a lumbar epidural catheter, and in 1979, Behar reported the first use of an epidural to administer narcotics.

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people who have normal blood clotting. Permanent neurological problems from bloody tap are extremely rare, estimated at less than 0.07% of occurrences. However, people who have a

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The use of epidural analgesia and anesthetic is considered safe and effective in most situations. Epidural analgesia is contraindicated in people who have complications such as

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use in newborns, and decreased risk of maternal hyperventilation. Some disadvantages of epidural analgesia versus opioids included longer labor durations, an increased need for

5154: 5085: 540:. It is unclear whether major surgery-related bleeding within 24 hours and the surgery-related complications up to 7 days after the procedure are affected by epidural use. 709:, designed with a 90-degree curved tip and side hole to redirect the inserted catheter vertically along the axis of the spine, may be inserted in the midline, between the 701:

is a commonly used anatomical landmark for lumbar epidural injections, as this level roughly corresponds with the fourth lumbar vertebra, which is usually well below the

451:. Due to the risk of disease progression, it is also potentially contraindicated in people with preexisting progressive neurologic disease. Some heart conditions such as 307:(IV) opioids and other common modalities of analgesia in childbirth. After an epidural is administered, a woman may not feel pain, but may still feel pressure. Epidural 4312:

Zhang J, Yancey MK, Klebanoff MA, Schwarz J, Schweitzer D (2001). "Does epidural analgesia prolong labor and increase risk of cesarean delivery? A natural experiment".

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may have a risk of epidural hematoma, and those with thrombocytopenia might bleed more than expected. A 2018 Cochrane review found no evidence regarding the effect of

3852:"Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review" 5233: 5147: 4304: 1428: 683: 341:

There is no overall difference in outcomes based on the time the epidural is administered to the mother, specifically no change in the rate of caesarean section,

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continuous infusion technique even when the total doses administered are identical. Typically, the effects of the epidural block are noted below a specific

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Agaram R, Douglas MJ, McTaggart RA, Gunka V (January 2009). "Inadequate pain relief with labor epidurals: a multivariate analysis of associated factors".

216:, for which the technique is considered safe and effective, and is considered more effective and safer than giving pain medication by mouth or through an 5050: 3983: 5095: 4702: 4618: 314:

Epidural analgesia is considered a safer and more effective method of relieving pain in labor as compared to intravenous or oral analgesia. In a 2018

4447: 2090:"Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia" 257:. Saline or air may be used to confirm placement in the epidural space. Alternatively, direct imaging of the injection area may be performed with a 5080: 786: 776: 5019: 3195:"Bacterial colonization of epidural catheters used for short-term postoperative analgesia: microbiological examination and risk factor analysis" 86: 4998: 2005:"Soft catheters reduce the risk of intravascular cannulation during epidural block—a retrospective analysis of 1,117 cases in a medical center" 3236:"Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized, controlled trial" 1267:"The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials" 5060: 3414: 2172: 1897: 1393:

Gendall KA, Kennedy RR, Watson AJ, Frizelle FA (2007). "The effect of epidural analgesia on postoperative outcome after colorectal surgery".

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Seyb ST, Berka RJ, Socol ML, Dooley SL (1999). "Risk of cesarean delivery with elective induction of labour at term in nulliparous women".

4666: 5518: 5090: 4901: 4484: 2142: 4978: 4777: 3901:"A multicenter randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labor" 3566:

Goerig M, Freitag M, Standl T (December 2002). "One hundred years of epidural anaesthesia—the men behind the technical development".

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Leighton BL, Halpern SH (2002). "The effects of epidural analgesia on labor, maternal, and neonatal outcomes: a systematic review".

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Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA, Wu CL (2003). "Efficacy of postoperative epidural analgesia: a meta-analysis".

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Dogliotti AM (1933). "Research and clinical observations on spinal anesthesia: with special reference to the peridural technique".

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Basse L, Werner M, Kehlet H (2000). "Is urinary drainage necessary during continuous epidural analgesia after colonic resection?".

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near the injection site or severe coagulopathy. In some cases, it may be contraindicated in people with low platelets, increased

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and the post-operative analgesic effects of an epidural are desired, both techniques may be used in combination. This is called

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In addition to blocking nerves which carry pain signals, local anesthetics may block nerves which carry other signals, though

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of the aortic or mitral valves are also a contraindication to the use of epidural administration, as is low blood pressure or

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Aram L, Krane EJ, Kozloski LJ, Yaster M (2001). "Tunneled epidural catheters for prolonged analgesia in pediatric patients".

3328:"Subcutaneous tunneling of caudal catheters reduces the rate of bacterial colonization to that of lumbar epidural catheters" 2970:"A comparison of a basal infusion with automated mandatory boluses in parturient-controlled epidural analgesia during labor" 5615: 2884:

Lim Y, Sia AT, Ocampo C (2005). "Automated regular boluses for epidural analgesia: a comparison with continuous infusion".

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Estcourt LJ, Malouf R, Hopewell S, Doree C, Van Veen J (April 30, 2018). Cochrane Haematological Malignancies Group (ed.).

5696: 5539: 5065: 5024: 4917: 4536: 4430: 2921:"A randomized comparison of programmed intermittent epidural bolus with continuous epidural infusion for labor analgesia" 1501:"Epidural analgesia versus patient-controlled intravenous analgesia for pain following intra-abdominal surgery in adults" 6108: 6070: 6032: 5375: 5191: 4572: 1914: 714: 424: 6123: 5984: 4922: 4587: 2284:"Successful Use of a 20% Lipid Emulsion to Resuscitate a Patient after a Presumed Bupivacaine-related Cardiac Arrest" 2331:

Mulroy MF (2002). "Systemic toxicity and cardiotoxicity from local anesthetics: incidence and preventive measures".

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Stark P (February 1979). "The effect of local anesthetic agents on afferent and motor nerve impulses in the frog".

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Troop M (2002). "Negative aspiration for cerebral fluid does not assure proper placement of epidural catheter".

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Suzuki R, Horiuchi S, Ohtsu H (September 2010). "Evaluation of the labor curve in nulliparous Japanese women".

1029: 759:, determined by the site of injection. A higher injection may result in sparing of nerve function in the lower 93: 4628: 6007: 6050: 5816: 5648: 5380: 5301: 5228: 5170: 5118: 4942: 4932: 4886: 4577: 4567: 4489: 3383: 912: 875: 713:. When using a paramedian approach, the tip of the needle passes along a shelf of vertebral bone called the 577: 145: 6045: 5999: 5941: 5847: 5714: 5321: 5195: 4993: 4881: 4215:"Perception of Epidural Analgesia for Labour Among Pregnant Women in a Nigerian Tertiary Hospital Setting" 4006:"A survey of epidural analgesia for labour in the United Kingdom: Epidural analgesia for labour in the UK" 2197: 1648:

White, Benjamin; Lopez, Victor; Chason, David; Scott, David; Stehel, Edward; Moore, William (2019-03-28).

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Antibas PL, do Nascimento Junior P, Braz LG, Vitor Pereira Doles J, Módolo NS, El Dib R (July 17, 2014).

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within a few hours of the epidural being stopped, with full recovery of normal function within 24 hours.

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Martinez Curbelo M (1949). "Continuous peridural segmental anesthesia by means of a ureteral catheter".

2597:"A simple epidural simulator: a blinded study assessing the 'feel' of loss of resistance in four fruits" 1422: 763:. For example, a thoracic epidural performed for upper abdominal surgery may not have any effect on the 444: 364: 2837:"The optimal distance that a multiorifice epidural catheter should be threaded into the epidural space" 1573:

Schneider B, Zheng P, Mattie R, Kennedy DJ (August 2, 2016). "Safety of epidural steroid injections".

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Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, Angelillo IF, Mosteller F (1998).

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Rice I, Wee MY, Thomson K (January 2004). "Obstetric epidurals and chronic adhesive arachnoiditis".

367:. Use of epidural analgesia after surgery in place of systemic analgesia is less likely to decrease 6103: 5953: 5690: 5571: 5566: 5286: 5182: 4785: 4643: 4633: 4524: 4514: 4479: 4474: 4418: 4401: 4360: 2376:"A dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects" 837:

The first record of an epidural injection is from 1885, when American neurologist James Corning of

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several days with little risk of bacterial infection, particularly if the skin is prepared with a

6027: 5821: 5776: 5473: 5218: 4871: 4727: 4597: 4509: 4494: 4457: 4442: 4435: 4160: 4035: 3930: 3797: 3665: 3499: 3456: 3357: 3308: 3265: 3140: 3042: 2999: 2950: 2866: 2817: 2711: 2626: 2446: 2356: 2313: 2264: 1598: 1444:"Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass" 1375: 1296: 1247: 1079: 842: 790: 782: 625: 516:, where anesthetic is delivered directly to the brainstem, causing unconsciousness and sometimes 484: 480: 157: 72: 68: 2731:"Air versus saline in the loss of resistance technique for identification of the epidural space" 1804:"Procedural sedation: A review of sedative agents, monitoring, and management of complications" 233:

from medicine. The most common complications of epidural injections include bleeding problems,

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Halpern SH, Muir H, Breen TW, Campbell DC, Barrett J, Liston R, Blanchard JW (November 2004).

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Behar M, Olshwang D, Magora F, Davidson J (1979). "Epidural morphine in treatment of pain".

3746: 3719: 3692: 3647: 3575: 3483: 3440: 3339: 3292: 3247: 3206: 3167: 3122: 3081: 3073: 3026: 2981: 2932: 2893: 2848: 2799: 2758: 2742: 2695: 2657: 2608: 2567: 2557: 2518: 2480: 2428: 2387: 2340: 2295: 2246: 2207: 2109: 2101: 2057: 2016: 1934: 1926: 1862: 1825: 1815: 1744: 1734: 1682: 1671:"Headache in the parturient: Pathophysiology and management of post-dural puncture headache" 1582: 1528: 1512: 1471: 1455: 1402: 1357: 1278: 1231: 1194: 1186: 1145: 1135: 1071: 1000: 992: 751: 702: 544: 537: 431:

due to dural puncture, which occurs in approximately 1.5% of epidural analgesia procedures.

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Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, Chan ES, Sia AT (October 9, 2014).

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An epidural injection may be administered at any point of the spine, but most commonly the

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opioids, some advantages of epidural analgesia versus opioids included fewer instances of

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is rarely used but has been extensively studied for management of analgesia during labor.

5139: 3211: 3194: 3111:"Bacterial colonization and infection rate of continuous epidural catheters in children" 1150: 1123: 299:) during childbirth. This usually involves epidural injection of a local anesthetic and 5762: 5722: 5395: 4825: 4820: 4732: 4387: 4231: 4214: 3917: 3900: 3652: 3635: 3593: 3344: 3327: 3086: 3061: 2986: 2969: 2937: 2920: 2804: 2787: 2763: 2730: 2572: 2545: 2433: 2416: 2114: 2089: 1939: 1830: 1803: 1749: 1722: 1533: 1500: 1476: 1443: 1199: 1174: 1005: 980: 853: 830: 653: 448: 395: 230: 186: 177: 149: 33: 3876: 3851: 3828: 3785: 3696: 3579: 2544:

Takahashi Y, Uvnäs-Moberg K, Nissen E, Lidfors L, Ransjö-Arvidson AB, Jonas W (2021).

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has not yet been applied. Depth markings may be seen along the shaft of the catheter.

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Jakobsen CJ (March 2015). "High Thoracic Epidural in Cardiac Anesthesia: A Review".

3460: 3361: 3312: 3269: 3144: 3046: 3003: 2954: 2870: 2821: 2715: 2450: 2360: 2317: 2046:"Incidence of neurologic complications related to thoracic epidural catheterization" 1602: 1406: 1300: 1251: 1083: 901: 5946: 5882: 5867: 5842: 5680: 5400: 5243: 4810: 4638: 4623: 3077: 2746: 2630: 2105: 1930: 1516: 1459: 1379: 1140: 996: 857: 760: 706: 671: 659: 525: 399: 245: 225: 205: 201: 3948:

Vincent RD J, Chestnut DH (November 15, 1998). "Epidural analgesia during labor".

1670: 1586: 17: 2613: 2596: 2485: 2468: 1346:"Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis" 99: 6040: 5928: 5801: 5757: 5735: 5653: 5623: 5557: 5406: 5345: 5174: 5014: 4722: 4676: 4464: 4352: 4261:, eMedicine: Physical Medicine and Rehabilitation (PM&R), August 2005. Also 3867: 1617: 735: 698: 493: 476: 456: 346: 283: 262: 153: 4191: 4066: 3171: 2897: 2021: 2004: 1866: 750:

If a short duration of action is desired, a single dose of medication called a

666:. In contact with the inner surface of the dura is another membrane called the 551:(1 in 168,000), neurological injury lasting longer than 1 year (1 in 240,000), 5924: 5895: 5455: 5429: 5291: 4762: 4557: 4383: 4129:

Glance LG, Wissler R, Glantz C, Osler TM, Mukamel DB, Dick AW (January 2007).

3977:

Epidural and Spinal Anesthesia Use During Labor: 27-state Reporting Area, 2008

3109:

Kost-Byerly S, Tobin JR, Greenberg RS, Billett C, Zahurak M, Yaster M (1998).

2562: 2469:"Postoperative urinary retention: anesthetic and perioperative considerations" 2251: 2234: 838: 663: 633: 597: 552: 440: 342: 279: 209: 140: 3683:

Edwards WB, Hingson RA (1942). "Continuous caudal anesthesia in obstetrics".

3487: 3060:

Simmons SW, Dennis AT, Cyna AM, Richardson MG, Bright MR (October 10, 2019).

2754: 1696: 1524: 1467: 1235: 1190: 390:

The injection of steroids into the epidural space is sometimes used to treat

204:

in or near the spinal cord. For this reason, epidurals are commonly used for

112: 5534: 5424: 5276: 5266: 4325: 4282: 4262: 3710:

Hingson RA, Edwards WE (1943). "Continuous Caudal Analgesia in Obstetrics".

2919:

Wong CA, Ratliff JT, Sullivan JT, Scavone BM, Toledo P, McCarthy RJ (2006).

2344: 1820: 1687: 613: 334:, and an increased risk of fever, low blood pressure, and muscle weakness. 308: 296: 165: 5784: 4333: 4290: 4240: 4199: 4156: 4115: 4074: 4031: 3926: 3885: 3836: 3758: 3495: 3452: 3353: 3304: 3261: 3220: 3179: 3095: 3038: 3030: 2995: 2946: 2905: 2813: 2772: 2707: 2622: 2581: 2530: 2494: 2352: 2309: 2260: 2219: 2123: 2030: 1948: 1874: 1839: 1758: 1629: 1594: 1542: 1485: 1414: 1371: 1243: 1208: 1159: 1041: 1014: 954: 3961: 3661: 3549: 3536:

Marx GF (1994). "The first spinal anesthesia. Who deserves the laurels?".

3517:

Corning JL (1885). "Spinal anaesthesia and local medication of the cord".

3375: 3136: 2862: 2671: 2522: 2442: 2401: 2071: 1989: 1292: 6076: 6065: 5857: 5837: 5832: 5806: 5750: 5643: 5633: 5628: 5385: 5331: 5296: 5281: 5223: 4707: 4406: 3062:"Combined spinal-epidural versus spinal anesthesia for caesarean section" 2211: 1785: 764: 601: 573: 517: 459:. An epidural is generally not used in people who are being administered 452: 327: 323: 234: 221: 181: 64: 3793: 500:

of more than 7 cm are at a higher risk of inadequate pain control.

5862: 5791: 5730: 5675: 5670: 5638: 5478: 5434: 5311: 2282:

Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB (2006).

1739: 274: 213: 107: 3444: 3234:

Kinirons B, Mimoz O, Lafendi L, Naas T, Meunier J, Nordmann P (2001).

2699: 543:

Rare complications of epidural administration include formation of an

121: 5852: 5772: 5685: 5505: 5416: 5306: 5271: 5258: 303:, commonly called an "epidural". This is more effective than oral or 300: 60: 54: 5488: 4257:

Boqing Chen and Patrick M. Foye, UMDNJ: New Jersey Medical School,

833:

visiting injured soldiers at the Docker Hospital in Melilla in 1909

5740: 5465: 5367: 5326: 5205: 4088:

Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA (September 2005).

2003:

Shih CK, Wang FY, Shieh CF, Huang JM, Lu IC, Wu LC, Lu DV (2012).

824: 682: 596: 489: 273: 249: 4259:

Epidural Steroid Injections: Non-surgical Treatment of Spine Pain

941:

Schrock SD, Harraway-Smith C (March 1, 2012). "Labor analgesia".

658:

An epidural is injected into the epidural space, inside the bony

3409:(8th ed.). Philadelphia: Wolters Kluwer. pp. 120–126. 475:

are more sensitive to the effects of the local anesthetics than

197: 5143: 4356: 4131:"Racial differences in the use of epidural analgesia for labor" 1124:"Early versus late initiation of epidural analgesia for labour" 5604: 5549: 5056:

American Society of Anesthesia Technologists & Technicians

1175:"Safe, healthy birth: what every pregnant woman needs to know" 295:

Epidural injections are commonly used to provide pain relief (

463:

as it increases the risk of complications from the epidural.

5783: 5721: 5614: 4090:"Obstetric anesthesia workforce survey: twenty-year update" 2788:"Ultrasound-guided epidural catheter insertion in children" 841:

in Morristown, New Jersey, used the technique to perform a

580:

is often placed for the duration of the epidural infusion.

5020:

Helsinki Declaration for Patient Safety in Anaesthesiology

4867:

Effects of early-life exposures to anesthesia on the brain

2235:"Erector spinae plane block: the ultimate 'plan A' block?" 1774:

Archives Internationales de Pharmacodynamie et de Therapie

5071:

Association of Anaesthetists of Great Britain and Ireland

2417:"Delayed respiratory arrest after epidural hydromorphone" 981:"Epidural versus non-epidural or no analgesia in labour" 345:, and duration of labor. There is also no change in the 32:"Epidural" redirects here. For the anatomical site, see 27:

Medication injected into the epidural space of the spine

3193:

Yuan HB, Zuo Z, Yu KW, Lin WM, Lee HC, Chan KH (2008).

220:. An epidural injection may also be used to administer 5101:

European Society of Anaesthesiology and Intensive Care

180:. Epidural administration involves the placement of a 1915:"Drugs for treating headache after a lumbar puncture" 979:

Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A (2018).

2467:

Baldini G, Bagry H, Aprikian A, Carli F (May 2009).

1499:

Salicath JH, Yeoh EC, Bennett MH (August 30, 2018).

781:

For some procedures where both the rapid onset of a

496:, those with a history of opiate use, or those with 6026: 5998: 5970: 5923: 5890: 5771: 5709: 5662: 5598: 5548: 5504: 5464: 5450: 5415: 5366: 5344: 5257: 5204: 5190: 5181: 5086:

Australian and New Zealand College of Anaesthetists

5043: 5007: 4956: 4910: 4844: 4776: 4695: 4659: 4606: 4545: 4394: 2688:

Neuromodulation: Technology at the Neural Interface

1030:"Epidurals: risks and concerns for mother and baby" 604:section of the spinal column (not drawn to scale). 106: 92: 80: 47: 3476:Seminars in Cardiothoracic and Vascular Anesthesia 2835:Beilin Y, Bernstein HH, Zucker-Pinchoff B (1995). 2233:Pawa A, King C, Thang C, White L (February 2023). 1723:"Epidural analgesia for labor: Current techniques" 1675:Journal of Obstetric Anaesthesia and Critical Care 900: 536:or epidural anesthesia for participants that have 318:of studies which compared epidural analgesia with 266:administration methods (such as oral medication). 200:, by blocking the transmission of signals through 4004:Burnstein R, Buckland R, Pickett JA (July 1999). 2595:Raj D, Williamson RM, Young D, Russell D (2013). 1323:. Oxford: Oxford University Press. p. 1038. 974: 972: 970: 968: 966: 964: 3739:Current Researches in Anesthesia & Analgesia 3617:Current Researches in Anesthesia & Analgesia 4219:Journal of the West African College of Surgeons 2167:. Oxford: Oxford University Press. p. 21. 1892:. Oxford: Oxford University Press. p. 20. 156:. The epidural route is used by physicians and 1117: 1115: 5155: 4368: 4180:American Journal of Obstetrics and Gynecology 4055:American Journal of Obstetrics and Gynecology 3407:Beckmann and Ling's obstetrics and gynecology 3326:Bubeck J, Boos K, Krause H, Thies KC (2004). 2646:"A greengrocer's model of the epidural space" 1568: 1566: 1564: 1562: 1560: 1558: 1556: 1554: 1552: 1314: 1312: 1310: 8: 4748:Intraoperative neurophysiological monitoring 1971: 1969: 4303:: CS1 maint: DOI inactive as of May 2024 ( 3712:Journal of the American Medical Association 2158: 2156: 1919:The Cochrane Database of Systematic Reviews 1505:The Cochrane Database of Systematic Reviews 1448:The Cochrane Database of Systematic Reviews 1427:: CS1 maint: DOI inactive as of May 2024 ( 1128:The Cochrane Database of Systematic Reviews 985:The Cochrane Database of Systematic Reviews 343:birth which must be assisted by instruments 5920: 5461: 5363: 5201: 5187: 5162: 5148: 5140: 5051:American Association of Nurse Anesthetists 4375: 4361: 4353: 3984:Centers for Disease Control and Prevention 1650:The lumbar epidural blood patch: A Primer. 1034:Midwifery Today with International Midwife 53: 5096:International Anesthesia Research Society 4703:ASA physical status classification system 4230: 4146: 4105: 4021: 3916: 3875: 3651: 3343: 3251: 3210: 3126: 3085: 2985: 2936: 2852: 2803: 2762: 2661: 2612: 2571: 2561: 2484: 2432: 2391: 2299: 2250: 2201: 2113: 2061: 2044:Giebler RM, Scherer RU, Peters J (1997). 2020: 1938: 1829: 1819: 1748: 1738: 1686: 1532: 1475: 1361: 1282: 1198: 1149: 1139: 1004: 148:in which a medicine is injected into the 4448:Combined spinal and epidural anaesthesia 5081:Association of Veterinary Anaesthetists 3975:Osterman M, Martin JA (April 6, 2011). 3066:Cochrane Database of Systematic Reviews 2735:Cochrane Database of Systematic Reviews 2374:Jacobson L, Chabal C, Brody MC (1988). 2094:Cochrane Database of Systematic Reviews 892: 787:combined spinal and epidural anesthesia 777:Combined spinal and epidural anesthesia 4296: 1420: 1344:Beattie WS, Badner NH, Choi P (2001). 192:Epidural anaesthesia causes a loss of 44: 5061:American Society of Anesthesiologists 3561: 3559: 2462: 2460: 2137: 2135: 2133: 2083: 2081: 1925:(7). The Cochrane Library: CD007887. 1797: 1795: 1716: 1714: 1712: 1710: 1708: 1706: 7: 5066:Anaesthesia Trauma and Critical Care 2143:"Epidurals and risk: it all depends" 1036:(81). Mothering No.133: 21–3, 63–6. 928:participating institution membership 278:Epidural infusion pump with opioid ( 5519:Heated humidified high-flow therapy 5091:Australian Society of Anaesthetists 4999:Physicians' assistant (anaesthesia) 4902:Postoperative residual curarization 4213:Okojie NQ, Isah EC (October 2014). 3433:Acta Anaesthesiologica Scandinavica 3212:10.1097/01.anes.0000296066.79547.f3 1802:Tobias JD, Leder M (October 2011). 771:Combined spinal-epidural techniques 146:method of medication administration 117: 4979:Operating department practitioners 3918:10.1213/01.ANE.0000136850.08972.07 3653:10.1111/j.1365-2044.1982.tb01279.x 3345:10.1213/01.ANE.0000130023.48259.FB 2987:10.1213/01.ane.0000253236.89376.60 2938:10.1213/01.ane.0000197778.57615.1a 2805:10.1213/01.ANE.0000156579.11254.D1 2786:Rapp HJ, Folger A, Grau T (2005). 2434:10.1111/j.1365-2044.1987.tb03982.x 67:. The site has been prepared with 25: 4989:Certified anesthesia technologist 4897:Postoperative nausea and vomiting 4412:Procedural sedation and analgesia 3634:Curelaru I, Sandu L (June 1982). 1401:(7): 584–98, discussion 598–600. 570:central nervous system depression 5961: 5487: 5248: 5242: 5123: 5114: 5113: 4530:Transverse abdominis plane block 4148:10.1097/00000542-200701000-00008 4107:10.1097/00000542-200509000-00030 4023:10.1046/j.1365-2044.1999.00894.x 3911:(5): 1532–8, table of contents. 3751:10.1213/00000539-194901000-00002 3724:10.1001/jama.1943.02840040001001 3596:(1921). "Anestesia metamérica". 3338:(3): 689–93, table of contents. 3297:10.1097/00000539-200106000-00016 3253:10.1097/00000542-200102000-00012 3128:10.1097/00000539-199804000-00007 2968:Sia AT, Lim Y, Ocampo C (2007). 2854:10.1097/00000539-199508000-00016 2663:10.1097/00000542-198902000-00038 2393:10.1213/00000539-198867110-00011 2301:10.1097/00000542-200607000-00033 2063:10.1097/00000542-199701000-00009 1442:Guay J, Kopp S (March 1, 2019). 1363:10.1097/00000539-200110000-00010 1284:10.1097/00000539-199803000-00032 1076:10.2165/00023210-199606060-00007 354:Pain relief during other surgery 5124: 5030:History of neuraxial anesthesia 4984:Certified anesthesia technician 4806:Double-lumen endobronchial tube 4667:Blood–gas partition coefficient 4500:Intravenous regional anesthesia 2798:(2): 333–9, table of contents. 1669:Nath G, Subrahmanyam M (2011). 1407:10.1111/j.1463-1318.2007.1274.x 821:History of neuraxial anesthesia 717:until just before reaching the 5076:Royal College of Anaesthetists 5035:History of tracheal intubation 4682:Minimum alveolar concentration 4619:Anesthesia provision in the US 3078:10.1002/14651858.CD008100.pub2 2747:10.1002/14651858.cd008938.pub2 2239:British Journal of Anaesthesia 2165:Oxford handbook of anaesthesia 2106:10.1002/14651858.CD011980.pub3 1931:10.1002/14651858.CD007887.pub3 1890:Oxford handbook of anaesthesia 1517:10.1002/14651858.CD010434.pub2 1460:10.1002/14651858.CD006715.pub3 1321:Oxford handbook of anaesthesia 1141:10.1002/14651858.CD007238.pub2 1028:Buckley S (January 24, 2014). 997:10.1002/14651858.CD000331.pub4 703:termination of the spinal cord 176:, and other medicines such as 1: 5287:Effervescent powder or tablet 5025:History of general anesthesia 4537:Total intravenous anaesthesia 4485:Inferior alveolar nerve block 4431:Continuous wound infiltration 3829:10.1016/S0029-7844(99)00377-4 3786:10.1016/S0140-6736(79)90947-4 3697:10.1016/S0002-9610(42)90599-3 3580:10.1016/s0531-5131(02)00770-7 3568:International Congress Series 2163:Wilson IH, Allman KG (2006). 1888:Wilson IH, Allman KG (2006). 1727:Local and Regional Anesthesia 1616:Tubben RE, Murphy PB (2018), 1587:10.1080/14740338.2016.1184246 1575:Expert Opinion on Drug Safety 1319:Wilson IH, Allman KG (2006). 765:area surrounding the genitals 402:caused by conditions such as 291:Pain relief during childbirth 6071:Patient-controlled analgesia 5376:Orally disintegrating tablet 4588:Neuromuscular-blocking drugs 3850:Liu EH, Sia AT (June 2004). 2614:10.1097/EJA.0b013e328361409c 2486:10.1097/ALN.0b013e31819f7aea 2415:Wüst HJ, Bromage PR (1987). 1808:Saudi Journal of Anaesthesia 1721:Silva M, Halpern SH (2010). 757:level or portion of the body 425:post-dural-puncture headache 4923:Critical emergency medicine 3868:10.1136/bmj.38097.590810.7C 3685:American Journal of Surgery 1913:Basurto O (July 15, 2015). 6140: 5582:Relative analgesia machine 4969:Anesthesiologist assistant 4831:Relative analgesia machine 4277:(5 Suppl Nature): S69–77. 4192:10.1016/j.ajog.2009.10.871 4067:10.1016/j.ajog.2010.04.014 3905:Anesthesia & Analgesia 3598:Revista de Sanidad Militar 3332:Anesthesia & Analgesia 3172:10.1089/109629602762539571 2974:Anesthesia & Analgesia 2925:Anesthesia & Analgesia 2898:10.1016/j.ijoa.2005.05.004 2792:Anesthesia & Analgesia 2380:Anesthesia & Analgesia 2022:10.1016/j.kjms.2012.02.004 1867:10.1016/j.ijoa.2007.10.008 1100:. Harvard University Press 818: 774: 651: 510:cerebral venous thrombosis 382:Epidural steroid injection 379: 31: 5959: 5485: 5240: 5109: 4877:Local anesthetic toxicity 3950:American Family Physician 2563:10.3389/fnins.2021.673184 2550:Frontiers in Neuroscience 2252:10.1016/j.bja.2023.01.012 1624:, StatPearls Publishing, 943:American Family Physician 908:Oxford English Dictionary 648:: interspinous ligaments. 408:degenerative disc disease 118: 52: 38:Epidural (disambiguation) 5171:Routes of administration 4892:Postanesthetic shivering 4758:Neuromuscular monitoring 4649:Rapid sequence induction 4578:Inhalational anesthetics 4348:MedlinePlus Encyclopedia 4285:(inactive May 9, 2024). 3519:New York Medical Journal 3488:10.1177/1089253214548764 1409:(inactive May 9, 2024). 1236:10.1001/jama.290.18.2455 1191:10.1624/105812409X461225 721:and the epidural space. 5697:Extra-amniotic infusion 5302:Molecular encapsulation 5234:Osmotic delivery system 5229:Time release technology 4943:Oral sedation dentistry 4933:Intensive care medicine 4887:Perioperative mortality 4743:Guedel's classification 4490:Intercostal nerve block 4326:10.1067/mob.2001.113874 4283:10.1067/mob.2002.121813 3384:National Health Service 2345:10.1053/rapm.2002.37127 1821:10.4103/1658-354X.87270 1688:10.4103/2249-4472.93988 913:Oxford University Press 876:National Health Service 492:people, those who have 467:Risks and complications 461:anticoagulation therapy 132:Epidural administration 48:Epidural administration 6114:Obstetrical procedures 6000:Central nervous system 5788: 5726: 5654:Mucoadhesive microdisc 5619: 4994:Anaesthetic technician 4882:Malignant hyperthermia 3031:10.1053/rapm.2000.9537 1618:"Epidural Blood Patch" 834: 689: 649: 404:spinal disc herniation 365:myocardial infarctions 287: 239:respiratory depression 36:. For other uses, see 5843:Transfersome vesicles 5787: 5725: 5702:Intravesical infusion 5618: 4816:Laryngeal mask airway 4660:Scientific principles 4629:Dogliotti's principle 4505:Occipital nerve block 4470:Brachial plexus block 2523:10.1089/bfm.2008.0002 2149:on February 18, 2012. 2009:Kaohsiung J. Med. Sci 828: 686: 662:but just outside the 600: 530:platelet transfusions 445:intracranial pressure 277: 224:for the treatment of 5529:Metered-dose inhaler 5514:Anesthetic vaporizer 4862:Drug-induced amnesia 4857:Anesthesia awareness 4791:Anesthetic vaporizer 4768:Thyromental distance 4672:Concentration effect 4546:Pharmacologic agents 4515:Pudendal nerve block 3405:Cassanova R (2018). 2644:Leighton BL (1989). 730:be conducted with a 555:(1 in 250,000), and 473:sensory nerve fibers 420:epidural blood patch 386:Epidural blood patch 332:uterine contractions 174:radiocontrast agents 6109:Regional anesthesia 5954:Transdermal implant 5914:(into tissue/blood) 5691:Intrauterine device 5572:Anaesthetic machine 5567:Oxygen concentrator 4786:Anaesthetic machine 4644:Tracheal intubation 4634:Intravenous therapy 4573:General anesthetics 4525:Sciatic nerve block 4480:Femoral nerve block 4475:Fascia iliaca block 4453:Epidural anesthesia 4419:Twilight anesthesia 4314:Am J Obstet Gynecol 4271:Am J Obstet Gynecol 3538:Regional Anesthesia 3160:Surgical Infections 3019:Reg Anesth Pain Med 2886:Int J Obstet Anesth 2333:Reg Anesth Pain Med 1855:Int J Obstet Anesth 1173:Lothian JA (2009). 911:(Online ed.). 865:Society and culture 732:portable ultrasound 644:: vertebral bones; 563:Medication-specific 481:intercostal muscles 429:cerebrospinal fluid 369:intestinal motility 259:portable ultrasound 59:A freshly inserted 6124:Spanish inventions 6066:Nanocell injection 5789: 5727: 5620: 5474:Dry-powder inhaler 4872:Emergence delirium 4852:Allergic reactions 4728:Entropy monitoring 4510:Paracervical block 4495:Interpleural block 4458:Spinal anaesthesia 4443:Neuraxial blockade 2601:Eur J Anaesthesiol 2212:10.1093/bja/aeh009 1740:10.2147/LRA.S10237 1395:Colorectal Disease 843:neuraxial blockade 835: 791:subarachnoid space 767:or pelvic organs. 690: 650: 640:: epidural space; 626:subarachnoid space 547:(1 in 145,000) or 485:thoracic diaphragm 477:motor nerve fibers 363:requirements, and 288: 282:) and anesthetic ( 172:medicines such as 158:nurse anesthetists 69:tincture of iodine 18:Epidural analgesia 6089: 6088: 6085: 6084: 5916: 5878:Transdermal spray 5873:Transdermal patch 5863:Medicated shampoo 5594: 5593: 5590: 5589: 5577:Medical inhalants 5524:Medical inhalants 5452:Respiratory tract 5446: 5445: 5340: 5339: 5137: 5136: 4974:Nurse anesthetist 4801:Bronchial blocker 4796:Arterial catheter 4687:Second gas effect 4614:Airway management 4583:Local anesthetics 4520:Retrobulbar block 3780:(8115): 527–529. 3445:10.1111/aas.12375 3416:978-1-4963-5309-2 2700:10.1111/ner.12693 2174:978-0-19-856609-0 1899:978-0-19-856609-0 1653:Applied Radiology 1330:978-0-19-856609-0 926:(Subscription or 783:spinal anesthetic 719:ligamentum flavum 711:spinous processes 549:epidural hematoma 506:subdural hematoma 498:cervical dilation 494:given birth prior 435:Contraindications 361:blood transfusion 286:) in a locked box 129: 128: 108:OPS-301 code 16:(Redirected from 6131: 5965: 5921: 5912: 5499: 5495: 5491: 5462: 5391:Sublingual drops 5364: 5252: 5246: 5202: 5188: 5164: 5157: 5150: 5141: 5127: 5126: 5117: 5116: 4964:Anesthesiologist 4753:Mallampati score 4713:Bispectral index 4553:Anticholinergics 4377: 4370: 4363: 4354: 4337: 4308: 4302: 4294: 4263:available online 4245: 4244: 4234: 4210: 4204: 4203: 4175: 4169: 4168: 4150: 4126: 4120: 4119: 4109: 4085: 4079: 4078: 4050: 4044: 4043: 4025: 4001: 3995: 3994: 3992: 3990: 3981: 3972: 3966: 3965: 3945: 3939: 3938: 3920: 3896: 3890: 3889: 3879: 3847: 3841: 3840: 3812: 3806: 3805: 3769: 3763: 3762: 3734: 3728: 3727: 3707: 3701: 3700: 3680: 3674: 3673: 3655: 3631: 3625: 3624: 3612: 3606: 3605: 3590: 3584: 3583: 3563: 3554: 3553: 3533: 3527: 3526: 3514: 3508: 3507: 3471: 3465: 3464: 3427: 3421: 3420: 3402: 3396: 3395: 3393: 3391: 3386:. March 11, 2020 3372: 3366: 3365: 3347: 3323: 3317: 3316: 3280: 3274: 3273: 3255: 3231: 3225: 3224: 3214: 3190: 3184: 3183: 3155: 3149: 3148: 3130: 3106: 3100: 3099: 3089: 3072:(10): CD008100. 3057: 3051: 3050: 3014: 3008: 3007: 2989: 2965: 2959: 2958: 2940: 2916: 2910: 2909: 2881: 2875: 2874: 2856: 2832: 2826: 2825: 2807: 2783: 2777: 2776: 2766: 2726: 2720: 2719: 2682: 2676: 2675: 2665: 2641: 2635: 2634: 2616: 2592: 2586: 2585: 2575: 2565: 2541: 2535: 2534: 2505: 2499: 2498: 2488: 2464: 2455: 2454: 2436: 2412: 2406: 2405: 2395: 2371: 2365: 2364: 2328: 2322: 2321: 2303: 2279: 2273: 2272: 2254: 2230: 2224: 2223: 2205: 2185: 2179: 2178: 2160: 2151: 2150: 2145:. Archived from 2139: 2128: 2127: 2117: 2085: 2076: 2075: 2065: 2041: 2035: 2034: 2024: 2000: 1994: 1993: 1973: 1964: 1963: 1957: 1955: 1942: 1910: 1904: 1903: 1885: 1879: 1878: 1850: 1844: 1843: 1833: 1823: 1799: 1790: 1789: 1769: 1763: 1762: 1752: 1742: 1718: 1701: 1700: 1690: 1666: 1660: 1646: 1640: 1639: 1638: 1636: 1613: 1607: 1606: 1581:(8): 1031–1039. 1570: 1547: 1546: 1536: 1511:(10): CD010434. 1496: 1490: 1489: 1479: 1439: 1433: 1432: 1426: 1418: 1390: 1384: 1383: 1365: 1341: 1335: 1334: 1316: 1305: 1304: 1286: 1262: 1256: 1255: 1219: 1213: 1212: 1202: 1170: 1164: 1163: 1153: 1143: 1134:(10): CD007238. 1119: 1110: 1109: 1107: 1105: 1094: 1088: 1087: 1059: 1053: 1052: 1050: 1048: 1025: 1019: 1018: 1008: 976: 959: 958: 938: 932: 931: 923: 921: 919: 904: 897: 740:intravenous line 578:urinary catheter 545:epidural abscess 538:thrombocytopenia 218:intravenous line 162:local anesthetic 122:edit on Wikidata 102: 57: 45: 21: 6139: 6138: 6134: 6133: 6132: 6130: 6129: 6128: 6094: 6093: 6090: 6081: 6061:Intraperitoneal 6033:musculoskeletal 6031: 6022: 5994: 5990:Intra-articular 5966: 5957: 5917: 5911: 5910: 5886: 5767: 5705: 5658: 5603: 5586: 5544: 5500: 5497: 5496: 5493: 5492: 5483: 5442: 5411: 5336: 5253: 5247: 5238: 5192:Digestive tract 5177: 5168: 5138: 5133: 5105: 5039: 5003: 4952: 4906: 4840: 4772: 4718:Body mass index 4691: 4655: 4602: 4568:Benzodiazepines 4541: 4390: 4381: 4344: 4311: 4295: 4268: 4254: 4252:Further reading 4249: 4248: 4212: 4211: 4207: 4186:(3): 273.e1–8. 4177: 4176: 4172: 4128: 4127: 4123: 4087: 4086: 4082: 4061:(3): 226.e1–6. 4052: 4051: 4047: 4003: 4002: 3998: 3988: 3986: 3979: 3974: 3973: 3969: 3947: 3946: 3942: 3898: 3897: 3893: 3849: 3848: 3844: 3814: 3813: 3809: 3771: 3770: 3766: 3736: 3735: 3731: 3709: 3708: 3704: 3682: 3681: 3677: 3633: 3632: 3628: 3614: 3613: 3609: 3592: 3591: 3587: 3565: 3564: 3557: 3535: 3534: 3530: 3516: 3515: 3511: 3473: 3472: 3468: 3429: 3428: 3424: 3417: 3404: 3403: 3399: 3389: 3387: 3374: 3373: 3369: 3325: 3324: 3320: 3282: 3281: 3277: 3233: 3232: 3228: 3192: 3191: 3187: 3157: 3156: 3152: 3108: 3107: 3103: 3059: 3058: 3054: 3016: 3015: 3011: 2967: 2966: 2962: 2918: 2917: 2913: 2883: 2882: 2878: 2834: 2833: 2829: 2785: 2784: 2780: 2741:(7): CD008938. 2728: 2727: 2723: 2684: 2683: 2679: 2643: 2642: 2638: 2594: 2593: 2589: 2543: 2542: 2538: 2507: 2506: 2502: 2466: 2465: 2458: 2414: 2413: 2409: 2373: 2372: 2368: 2330: 2329: 2325: 2281: 2280: 2276: 2232: 2231: 2227: 2203:10.1.1.532.6709 2187: 2186: 2182: 2175: 2162: 2161: 2154: 2141: 2140: 2131: 2100:(4): CD011980. 2087: 2086: 2079: 2043: 2042: 2038: 2002: 2001: 1997: 1975: 1974: 1967: 1953: 1951: 1912: 1911: 1907: 1900: 1887: 1886: 1882: 1852: 1851: 1847: 1801: 1800: 1793: 1771: 1770: 1766: 1720: 1719: 1704: 1668: 1667: 1663: 1647: 1643: 1634: 1632: 1615: 1614: 1610: 1572: 1571: 1550: 1498: 1497: 1493: 1454:(3): CD006715. 1441: 1440: 1436: 1419: 1392: 1391: 1387: 1343: 1342: 1338: 1331: 1318: 1317: 1308: 1264: 1263: 1259: 1230:(18): 2455–63. 1221: 1220: 1216: 1172: 1171: 1167: 1121: 1120: 1113: 1103: 1101: 1096: 1095: 1091: 1061: 1060: 1056: 1046: 1044: 1027: 1026: 1022: 991:(5): CD000331. 978: 977: 962: 940: 939: 935: 925: 917: 915: 899: 898: 894: 889: 867: 829:Spanish doctor 823: 817: 799: 779: 773: 748: 746:Use and removal 681: 668:arachnoid mater 656: 608:: spinal cord; 595: 590: 565: 534:lumbar puncture 469: 447:, or decreased 437: 427:and leakage of 416:type 2 diabetes 412:spinal stenosis 392:nerve root pain 388: 380:Main articles: 378: 356: 316:Cochrane review 293: 272: 231:adverse effects 178:glucocorticoids 125: 98: 76: 41: 28: 23: 22: 15: 12: 11: 5: 6137: 6135: 6127: 6126: 6121: 6116: 6111: 6106: 6096: 6095: 6087: 6086: 6083: 6082: 6080: 6079: 6074: 6068: 6063: 6058: 6053: 6048: 6043: 6037: 6035: 6024: 6023: 6021: 6020: 6015: 6010: 6004: 6002: 5996: 5995: 5993: 5992: 5987: 5982: 5980:Intracavernous 5976: 5974: 5968: 5967: 5960: 5958: 5956: 5951: 5950: 5949: 5939: 5934: 5932: 5918: 5909: 5908: 5903: 5898: 5892: 5891: 5888: 5887: 5885: 5880: 5875: 5870: 5865: 5860: 5855: 5850: 5845: 5840: 5835: 5830: 5825: 5819: 5814: 5809: 5804: 5799: 5794: 5782: 5780: 5769: 5768: 5766: 5765: 5763:Nutrient enema 5760: 5755: 5754: 5753: 5748: 5738: 5733: 5720: 5718: 5707: 5706: 5704: 5699: 5694: 5688: 5683: 5678: 5673: 5668: 5666: 5660: 5659: 5657: 5656: 5651: 5646: 5641: 5636: 5631: 5626: 5613: 5611: 5596: 5595: 5592: 5591: 5588: 5587: 5585: 5584: 5579: 5574: 5569: 5564: 5554: 5552: 5546: 5545: 5543: 5542: 5537: 5532: 5526: 5521: 5516: 5510: 5508: 5502: 5501: 5486: 5484: 5482: 5481: 5476: 5470: 5468: 5459: 5448: 5447: 5444: 5443: 5441: 5440: 5437: 5432: 5427: 5421: 5419: 5413: 5412: 5410: 5409: 5404: 5398: 5393: 5388: 5383: 5378: 5372: 5370: 5361: 5342: 5341: 5338: 5337: 5335: 5334: 5329: 5324: 5319: 5314: 5309: 5304: 5299: 5294: 5289: 5284: 5279: 5274: 5269: 5263: 5261: 5255: 5254: 5241: 5239: 5237: 5236: 5231: 5226: 5221: 5216: 5210: 5208: 5199: 5185: 5179: 5178: 5169: 5167: 5166: 5159: 5152: 5144: 5135: 5134: 5132: 5131: 5121: 5110: 5107: 5106: 5104: 5103: 5098: 5093: 5088: 5083: 5078: 5073: 5068: 5063: 5058: 5053: 5047: 5045: 5041: 5040: 5038: 5037: 5032: 5027: 5022: 5017: 5011: 5009: 5005: 5004: 5002: 5001: 4996: 4991: 4986: 4981: 4976: 4971: 4966: 4960: 4958: 4954: 4953: 4951: 4950: 4945: 4940: 4935: 4930: 4925: 4920: 4918:Cardiothoracic 4914: 4912: 4911:Subspecialties 4908: 4907: 4905: 4904: 4899: 4894: 4889: 4884: 4879: 4874: 4869: 4864: 4859: 4854: 4848: 4846: 4842: 4841: 4839: 4838: 4833: 4828: 4826:Magill forceps 4823: 4821:Laryngeal tube 4818: 4813: 4808: 4803: 4798: 4793: 4788: 4782: 4780: 4774: 4773: 4771: 4770: 4765: 4760: 4755: 4750: 4745: 4740: 4735: 4733:Fick principle 4730: 4725: 4720: 4715: 4710: 4705: 4699: 4697: 4693: 4692: 4690: 4689: 4684: 4679: 4674: 4669: 4663: 4661: 4657: 4656: 4654: 4653: 4652: 4651: 4641: 4636: 4631: 4626: 4621: 4616: 4610: 4608: 4604: 4603: 4601: 4600: 4595: 4590: 4585: 4580: 4575: 4570: 4565: 4563:Butyrophenones 4560: 4555: 4549: 4547: 4543: 4542: 4540: 4539: 4534: 4533: 4532: 4527: 4522: 4517: 4512: 4507: 4502: 4497: 4492: 4487: 4482: 4477: 4472: 4462: 4461: 4460: 4455: 4450: 4440: 4439: 4438: 4433: 4423: 4422: 4421: 4416: 4415: 4414: 4398: 4396: 4392: 4391: 4388:anesthesiology 4382: 4380: 4379: 4372: 4365: 4357: 4351: 4350: 4343: 4342:External links 4340: 4339: 4338: 4309: 4266: 4253: 4250: 4247: 4246: 4205: 4170: 4135:Anesthesiology 4121: 4094:Anesthesiology 4080: 4045: 4016:(7): 634–640. 3996: 3967: 3956:(8): 1785–92. 3940: 3891: 3862:(7453): 1410. 3842: 3823:(4): 600–607. 3817:Obstet Gynecol 3807: 3764: 3729: 3702: 3675: 3626: 3607: 3600:(in Spanish). 3585: 3555: 3528: 3509: 3466: 3439:(8): 923–932. 3422: 3415: 3397: 3367: 3318: 3275: 3240:Anesthesiology 3226: 3199:Anesthesiology 3185: 3150: 3101: 3052: 3025:(5): 498–501. 3009: 2960: 2911: 2876: 2827: 2778: 2721: 2694:(7): 625–640. 2677: 2650:Anesthesiology 2636: 2587: 2536: 2511:Breastfeed Med 2500: 2479:(5): 1139–57. 2473:Anesthesiology 2456: 2407: 2386:(11): 1082–8. 2366: 2323: 2288:Anesthesiology 2274: 2245:(5): 497–502. 2225: 2180: 2173: 2152: 2129: 2077: 2050:Anesthesiology 2036: 1995: 1965: 1905: 1898: 1880: 1845: 1814:(4): 395–410. 1791: 1764: 1702: 1661: 1641: 1608: 1548: 1491: 1434: 1385: 1336: 1329: 1306: 1277:(3): 598–612. 1257: 1214: 1179:J Perinat Educ 1165: 1111: 1089: 1070:(6): 474–497. 1054: 1020: 960: 933: 891: 890: 888: 885: 866: 863: 819:Main article: 816: 813: 798: 795: 775:Main article: 772: 769: 747: 744: 680: 677: 654:Epidural space 652:Main article: 594: 591: 589: 586: 564: 561: 468: 465: 449:cardiac output 436: 433: 396:radicular pain 377: 374: 355: 352: 292: 289: 271: 268: 160:to administer 150:epidural space 138:ἐπί, "upon" + 127: 126: 119: 116: 115: 110: 104: 103: 96: 90: 89: 84: 78: 77: 58: 50: 49: 34:Epidural space 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 6136: 6125: 6122: 6120: 6117: 6115: 6112: 6110: 6107: 6105: 6102: 6101: 6099: 6092: 6078: 6075: 6072: 6069: 6067: 6064: 6062: 6059: 6057: 6054: 6052: 6051:Intramuscular 6049: 6047: 6044: 6042: 6039: 6038: 6036: 6034: 6029: 6025: 6019: 6016: 6014: 6011: 6009: 6008:Intracerebral 6006: 6005: 6003: 6001: 5997: 5991: 5988: 5986: 5983: 5981: 5978: 5977: 5975: 5973: 5969: 5964: 5955: 5952: 5948: 5945: 5944: 5943: 5940: 5938: 5935: 5933: 5930: 5926: 5922: 5919: 5915: 5907: 5904: 5902: 5899: 5897: 5894: 5893: 5889: 5884: 5881: 5879: 5876: 5874: 5871: 5869: 5866: 5864: 5861: 5859: 5856: 5854: 5851: 5849: 5846: 5844: 5841: 5839: 5836: 5834: 5831: 5829: 5828:Iontophoresis 5826: 5823: 5820: 5818: 5815: 5813: 5810: 5808: 5805: 5803: 5800: 5798: 5797:Topical cream 5795: 5793: 5790: 5786: 5781: 5778: 5774: 5770: 5764: 5761: 5759: 5756: 5752: 5749: 5747: 5744: 5743: 5742: 5739: 5737: 5734: 5732: 5729: 5728: 5724: 5719: 5716: 5712: 5708: 5703: 5700: 5698: 5695: 5692: 5689: 5687: 5684: 5682: 5679: 5677: 5674: 5672: 5669: 5667: 5665: 5661: 5655: 5652: 5650: 5647: 5645: 5642: 5640: 5637: 5635: 5632: 5630: 5627: 5625: 5622: 5621: 5617: 5612: 5610: 5606: 5601: 5597: 5583: 5580: 5578: 5575: 5573: 5570: 5568: 5565: 5563: 5562:Nasal cannula 5559: 5556: 5555: 5553: 5551: 5547: 5541: 5538: 5536: 5533: 5530: 5527: 5525: 5522: 5520: 5517: 5515: 5512: 5511: 5509: 5507: 5503: 5490: 5480: 5477: 5475: 5472: 5471: 5469: 5467: 5463: 5460: 5457: 5453: 5449: 5438: 5436: 5433: 5431: 5428: 5426: 5423: 5422: 5420: 5418: 5414: 5408: 5405: 5402: 5399: 5397: 5394: 5392: 5389: 5387: 5384: 5382: 5379: 5377: 5374: 5373: 5371: 5369: 5365: 5362: 5359: 5355: 5351: 5347: 5343: 5333: 5330: 5328: 5325: 5323: 5320: 5318: 5315: 5313: 5310: 5308: 5305: 5303: 5300: 5298: 5295: 5293: 5290: 5288: 5285: 5283: 5280: 5278: 5275: 5273: 5270: 5268: 5265: 5264: 5262: 5260: 5256: 5251: 5245: 5235: 5232: 5230: 5227: 5225: 5222: 5220: 5217: 5215: 5212: 5211: 5209: 5207: 5203: 5200: 5197: 5193: 5189: 5186: 5184: 5180: 5176: 5172: 5165: 5160: 5158: 5153: 5151: 5146: 5145: 5142: 5130: 5122: 5120: 5112: 5111: 5108: 5102: 5099: 5097: 5094: 5092: 5089: 5087: 5084: 5082: 5079: 5077: 5074: 5072: 5069: 5067: 5064: 5062: 5059: 5057: 5054: 5052: 5049: 5048: 5046: 5044:Organizations 5042: 5036: 5033: 5031: 5028: 5026: 5023: 5021: 5018: 5016: 5013: 5012: 5010: 5006: 5000: 4997: 4995: 4992: 4990: 4987: 4985: 4982: 4980: 4977: 4975: 4972: 4970: 4967: 4965: 4962: 4961: 4959: 4955: 4949: 4948:Pain medicine 4946: 4944: 4941: 4939: 4936: 4934: 4931: 4929: 4926: 4924: 4921: 4919: 4916: 4915: 4913: 4909: 4903: 4900: 4898: 4895: 4893: 4890: 4888: 4885: 4883: 4880: 4878: 4875: 4873: 4870: 4868: 4865: 4863: 4860: 4858: 4855: 4853: 4850: 4849: 4847: 4845:Complications 4843: 4837: 4836:Tracheal tube 4834: 4832: 4829: 4827: 4824: 4822: 4819: 4817: 4814: 4812: 4809: 4807: 4804: 4802: 4799: 4797: 4794: 4792: 4789: 4787: 4784: 4783: 4781: 4779: 4775: 4769: 4766: 4764: 4761: 4759: 4756: 4754: 4751: 4749: 4746: 4744: 4741: 4739: 4738:Goldman index 4736: 4734: 4731: 4729: 4726: 4724: 4721: 4719: 4716: 4714: 4711: 4709: 4706: 4704: 4701: 4700: 4698: 4694: 4688: 4685: 4683: 4680: 4678: 4675: 4673: 4670: 4668: 4665: 4664: 4662: 4658: 4650: 4647: 4646: 4645: 4642: 4640: 4637: 4635: 4632: 4630: 4627: 4625: 4622: 4620: 4617: 4615: 4612: 4611: 4609: 4605: 4599: 4596: 4594: 4591: 4589: 4586: 4584: 4581: 4579: 4576: 4574: 4571: 4569: 4566: 4564: 4561: 4559: 4556: 4554: 4551: 4550: 4548: 4544: 4538: 4535: 4531: 4528: 4526: 4523: 4521: 4518: 4516: 4513: 4511: 4508: 4506: 4503: 4501: 4498: 4496: 4493: 4491: 4488: 4486: 4483: 4481: 4478: 4476: 4473: 4471: 4468: 4467: 4466: 4463: 4459: 4456: 4454: 4451: 4449: 4446: 4445: 4444: 4441: 4437: 4434: 4432: 4429: 4428: 4427: 4424: 4420: 4417: 4413: 4410: 4409: 4408: 4405: 4404: 4403: 4400: 4399: 4397: 4393: 4389: 4385: 4378: 4373: 4371: 4366: 4364: 4359: 4358: 4355: 4349: 4346: 4345: 4341: 4335: 4331: 4327: 4323: 4320:(1): 128–34. 4319: 4315: 4310: 4306: 4300: 4292: 4288: 4284: 4280: 4276: 4272: 4267: 4264: 4260: 4256: 4255: 4251: 4242: 4238: 4233: 4228: 4225:(4): 142–62. 4224: 4220: 4216: 4209: 4206: 4201: 4197: 4193: 4189: 4185: 4181: 4174: 4171: 4166: 4162: 4158: 4154: 4149: 4144: 4140: 4136: 4132: 4125: 4122: 4117: 4113: 4108: 4103: 4100:(3): 645–53. 4099: 4095: 4091: 4084: 4081: 4076: 4072: 4068: 4064: 4060: 4056: 4049: 4046: 4041: 4037: 4033: 4029: 4024: 4019: 4015: 4011: 4007: 4000: 3997: 3985: 3978: 3971: 3968: 3963: 3959: 3955: 3951: 3944: 3941: 3936: 3932: 3928: 3924: 3919: 3914: 3910: 3906: 3902: 3895: 3892: 3887: 3883: 3878: 3873: 3869: 3865: 3861: 3857: 3853: 3846: 3843: 3838: 3834: 3830: 3826: 3822: 3818: 3811: 3808: 3803: 3799: 3795: 3791: 3787: 3783: 3779: 3775: 3768: 3765: 3760: 3756: 3752: 3748: 3744: 3740: 3733: 3730: 3725: 3721: 3717: 3713: 3706: 3703: 3698: 3694: 3691:(3): 459–64. 3690: 3686: 3679: 3676: 3671: 3667: 3663: 3659: 3654: 3649: 3645: 3641: 3637: 3630: 3627: 3622: 3618: 3611: 3608: 3603: 3599: 3595: 3589: 3586: 3581: 3577: 3573: 3569: 3562: 3560: 3556: 3551: 3547: 3544:(6): 429–30. 3543: 3539: 3532: 3529: 3524: 3520: 3513: 3510: 3505: 3501: 3497: 3493: 3489: 3485: 3481: 3477: 3470: 3467: 3462: 3458: 3454: 3450: 3446: 3442: 3438: 3434: 3426: 3423: 3418: 3412: 3408: 3401: 3398: 3385: 3381: 3377: 3371: 3368: 3363: 3359: 3355: 3351: 3346: 3341: 3337: 3333: 3329: 3322: 3319: 3314: 3310: 3306: 3302: 3298: 3294: 3291:(6): 1432–8. 3290: 3286: 3279: 3276: 3271: 3267: 3263: 3259: 3254: 3249: 3246:(2): 239–44. 3245: 3241: 3237: 3230: 3227: 3222: 3218: 3213: 3208: 3204: 3200: 3196: 3189: 3186: 3181: 3177: 3173: 3169: 3166:(4): 359–65. 3165: 3161: 3154: 3151: 3146: 3142: 3138: 3134: 3129: 3124: 3120: 3116: 3112: 3105: 3102: 3097: 3093: 3088: 3083: 3079: 3075: 3071: 3067: 3063: 3056: 3053: 3048: 3044: 3040: 3036: 3032: 3028: 3024: 3020: 3013: 3010: 3005: 3001: 2997: 2993: 2988: 2983: 2979: 2975: 2971: 2964: 2961: 2956: 2952: 2948: 2944: 2939: 2934: 2930: 2926: 2922: 2915: 2912: 2907: 2903: 2899: 2895: 2891: 2887: 2880: 2877: 2872: 2868: 2864: 2860: 2855: 2850: 2846: 2842: 2838: 2831: 2828: 2823: 2819: 2815: 2811: 2806: 2801: 2797: 2793: 2789: 2782: 2779: 2774: 2770: 2765: 2760: 2756: 2752: 2748: 2744: 2740: 2736: 2732: 2725: 2722: 2717: 2713: 2709: 2705: 2701: 2697: 2693: 2689: 2681: 2678: 2673: 2669: 2664: 2659: 2655: 2651: 2647: 2640: 2637: 2632: 2628: 2624: 2620: 2615: 2610: 2606: 2602: 2598: 2591: 2588: 2583: 2579: 2574: 2569: 2564: 2559: 2555: 2551: 2547: 2540: 2537: 2532: 2528: 2524: 2520: 2516: 2512: 2504: 2501: 2496: 2492: 2487: 2482: 2478: 2474: 2470: 2463: 2461: 2457: 2452: 2448: 2444: 2440: 2435: 2430: 2426: 2422: 2418: 2411: 2408: 2403: 2399: 2394: 2389: 2385: 2381: 2377: 2370: 2367: 2362: 2358: 2354: 2350: 2346: 2342: 2339:(6): 556–61. 2338: 2334: 2327: 2324: 2319: 2315: 2311: 2307: 2302: 2297: 2293: 2289: 2285: 2278: 2275: 2270: 2266: 2262: 2258: 2253: 2248: 2244: 2240: 2236: 2229: 2226: 2221: 2217: 2213: 2209: 2204: 2199: 2196:(1): 109–20. 2195: 2191: 2184: 2181: 2176: 2170: 2166: 2159: 2157: 2153: 2148: 2144: 2138: 2136: 2134: 2130: 2125: 2121: 2116: 2111: 2107: 2103: 2099: 2095: 2091: 2084: 2082: 2078: 2073: 2069: 2064: 2059: 2055: 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