Anesthesiology
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The anatomic findings from cryomicrotome sections of 38 cadaver lumbar spines are reported. The technique produces high-resolution planar images of undisturbed epidural anatomy. Several observations differ from previous reports that used methods more prone to artifact. ⋯ The space anterior to the dura is filled with veins and is isolated from the rest of the epidural space by a membranous lateral extension of the posterior longitudinal ligament. This membrane and a midline posterior fat pedicle are the only observed potential barriers to the spread of epidural solutions. These findings may be important in understanding the mechanics and pharmacokinetics of solutions injected into the epidural space and in refining techniques for needle and catheter placement.
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Recently there have been several reports of postoperative sepsis due to the intravenous injection of contaminated solutions of propofol (Diprivan). The mechanism by which this contamination occurred has not been identified. This study sought to determine whether bacterial contamination of the contents of glass ampules can be decreased by swabbing the neck of the vial with alcohol prior to opening. ⋯ The contents of all ampules that had been wiped with alcohol prior to being opened remained sterile (P less than 0.001 vs. non-alcohol-treated group for propofol ampules and P = 0.20 vs. non-alcohol-treated group for lidocaine ampules). These data suggest that bacterial contamination of propofol and lidocaine may occur as a result of opening glass ampules. Wiping the outside of the ampule with alcohol immediately prior to opening may decrease this risk.