title: Intentional puncture of the dural space as an aid to epidural placement in a morbidly obese parturient.
abstract: OBJECTIVE
  In this case report the authors discuss a technique occasionally employed at their institution to aid in identification of the epidural space in morbidly obese parturients.
  
  
  METHODS
  A 29-year-old primagravida, with a body mass index of 90 (155 cm tall, 215 kg) presented for induction of labor. A 27-ga. Sprotte spinal needle was intentionally passed through a Weiss epidural needle and into the subarachnoid space to confirm placement of the Weiss needle in the epidural space. An epidural catheter was then placed which functioned well for labor and subsequent caesarian delivery.
  
  
  CONCLUSIONS
  In selected patients, intentional puncture of the dura can aid in confirmation of the epidural space.
authors.affiliation: Department of Anesthesiology, University of Mississippi School of Medicine, Jackson, Mississippi, USA.
authors.forename: G
authors.initials: G
authors.lastname: Mychaskiw
authors.forename: T
authors.initials: T
authors.lastname: Panigrahi
authors.forename: T
authors.initials: T
authors.lastname: Ray
authors.forename: S
authors.initials: S
authors.lastname: Shah
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000295:instrumentation* / Q000379:methods*; D015992:Body Mass Index; D002585:Cesarean Section; D004824:Epidural Space / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D009339:Needles; D009767:Obesity, Morbid / Q000175:diagnosis*; D011247:Pregnancy; D011677:Punctures; D012680:Sensitivity and Specificity