Hydrodynamics of the spinal epidural space in pigs determined by constant-flow methods.
OBJECTIVE
Impressive quantities of fluid can be infused into the epidural space of the spine without causing dramatic or sustained increases in pressure. The epidural space is considered "leaky," but questions remain about how fluid leaves the epidural space. We used constant-flow infusions of saline to gain insight into the hydrodynamics involved.


METHODS
We infused saline at a constant rate into the lumbar epidural space of 6 anesthetized pigs while measuring pressure at the adjacent interspace. Three or 4 infusions were performed at different flow rates in each animal.


RESULTS
Epidural space pressure in the absence of flow was consistently 2 to 3 mm Hg above right atrial pressure. During each infusion, pressure increased slowly to a steady plateau value between 15 and 70 mm Hg. When flow was stopped, pressure declined exponentially to the starting pressure. The presence of a plateau indicates that fluid leaving the epidural space ends up in a structure with high capacitance. Plateau pressures were linearly related to flow rate in each animal, indicating constant resistance to outflow. The flow-pressure relation showed neither a critical opening pressure nor moderating pressures with increased flow.


CONCLUSIONS
Fluid leaves the porcine spinal epidural space through channels that are open at baseline rather than being recruited as epidural pressure increases. This behavior is inconsistent with the view that the epidural space behaves like a Starling resistor.
Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA 15213, USA. Buffingtoncs@anes.upmc.edu
Charles W
CW
Buffington
Elisabet U M
EU
Nystrom
D000818:Animals; D015170:Cerebrospinal Fluid Pressure / Q000187:drug effects / Q000502:physiology*; D004824:Epidural Space / Q000187:drug effects / Q000502:physiology*; D007260:Infusion Pumps; D007268:Injections, Epidural; D008297:Male; D012965:Sodium Chloride / Q000008:administration & dosage; D013552:Swine; D014160:Transducers, Pressure
D012965:Sodium Chloride