title: There is high incidence of skin cells in the first and third drops of cerebrospinal fluid in spinal anesthesia.
abstract: OBJECTIVE
  Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the first and third drops of CSF of patients undergoing spinal anesthesia.
  
  
  METHODS
  Samples of the first and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the first drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly.
  
  
  RESULTS
  Squamous epithelial cells were identified in 35 (89.7%) samples from the first drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the first drop (p=0.046). Nucleated epithelial cells were found in a sample of the first drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than first drop with no statistical difference (p=0.257).
  
  
  CONCLUSIONS
  High percentage of epithelial cells was found in the first (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel.
authors.affiliation: Anesthesia Study Center, Goiânia, GO, Brazil. mhctaveira@superig.com.br
authors.forename: Mário Humberto Curado
authors.initials: MH
authors.lastname: Taveira
authors.forename: Antonio Fernando
authors.initials: AF
authors.lastname: Carneiro
authors.forename: Gustavo Gabriel
authors.initials: GG
authors.lastname: Rassi
authors.forename: Marise Amaral Rebouças
authors.initials: MA
authors.lastname: Moreira
authors.forename: Simone de Andrade Curado
authors.initials: Sde A
authors.lastname: Taveira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D002452:Cell Count; D002555:Cerebrospinal Fluid / Q000166:cytology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000166:cytology*; D055815:Young Adult