CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Jagannathan, N.
Right arrow Articles by Tetzlaff, J. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Jagannathan, N.
Right arrow Articles by Tetzlaff, J. E.
Canadian Journal of Anesthesia 52:113 (2005)
© Canadian Anesthesiologists' Society, 2005

Correspondence

Epidural blood patch in a Jehovah’s Witness patient with post-dural puncture cephalgia

Narasimhan Jagannathan, MD and John E. Tetzlaff, MD

Cleveland, Ohio

To the Editor:

We report a case of epidural blood patch in a Jehovah’s Witness (JW) parturient by using a continuous circuit technique.1

A young healthy primigravida was scheduled for an elective Cesarean delivery under epidural anesthesia. Accidental dural puncture occurred and the catheter was inserted into the subarachnoid space. 12.5 mg of 0.5% bupivacaine and 25 µg of fentanyl were injected and the Cesarean section was completed uneventfully under a spinal anesthetic.

The subarachnoid catheter was left in place and was removed on postoperative day (POD)1. Subsequently she developed a postural, occipital headache consistent with post-dural puncture headache. Initially, hydration, analgesics and iv caffeine were tried, but failed to achieve relief. The possibility of a blood patch was discussed on POD 2, but the patient refused this treatment option and opted for epidural saline. On POD 3, the patient’s headache was severe and prevented discharge from the hospital. She accepted the blood patch with the condition that the blood used remain in a continuous circuit. Utilizing this principle, a continuous circuit was established (FigureGo). After placement of an 18-gauge Tuohy needle in the L2–L3 epidural space, a four-way stopcock was connected to the needle along with a 20-mL syringe. Using an aseptic technique, an 18 -gauge iv catheter was placed in the left antecubital fossa and connected to a sterile iv extension tubing. Subsequently a 36-inch pressure tubing with male luer locks on both ends was connected to the iv extension tubing. The other end was connected to the four-way stopcock completing the circuit. Twenty millilitres of blood were aspirated and injected into the epidural space, providing complete relief within two hours. The patient was discharged home on POD 4 and remained free of complications.



View larger version (131K):
[in this window]
[in a new window]
  		FIGURE Continuous system for obtaining autologous blood and injecting into the epidural space for a blood patch under sterile conditions.

 
Management of an epidural blood patch can be a challenge in the JW patient. The JW belief is that "a Christian ought to focus, not primarily on whether a brief interruption in flow might occur, but on whether he conscientiously believed that the diverted blood would still be part of his circulatory system".2 Our montage is acceptable since the JW patient believes that, despite the stopcock, the tubing acts as an external conduit for blood to flow, even though the flow may be interrupted briefly. We believe that this method is more user friendly than other methods described3–5 and will be accepted by most JW parturients.

References

1 Muramoto O. Recent developments in medical care of Jehovah’s Witnesses. West J Med 1999; 170: 297–301.[Medline]

2 Watch Tower Bible and Tract Society. Questions from readers. The Watchtower 1989; March 1: 30–1.

3 Brimbacombe J, Clarke G, Craig L. Epidural blood patch in the Jehovah’s Witness (Letter). Anaesth Intensive Care 1994; 22: 319.

4 Bearb ME, Pennant JH. Epidural blood patch in a Jehovah’s Witness (Letter). Anesth Analg 1987; 66: 1052.[Free Full Text]

5 Kanumilli V, Kaza R, Johnson C, Nowacki C. Epidural blood patch for Jehovah’s Witness patient (Letter). Anesth Analg 1993; 77: 872–3.[Free Full Text]





This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Jagannathan, N.
Right arrow Articles by Tetzlaff, J. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Jagannathan, N.
Right arrow Articles by Tetzlaff, J. E.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS