Lumbar Drains

[MTGas2B]

I was wondering how often you guys place lumbar drains? Traditionally in my institution they have been the realm of the neuro anesthesia folks. Recently though it seems the vascular guys are asking us to place them more often for some of their aortic aneurysm repairs, even endovascular repairs. I was curious if you guys deal with them much, especially the some of the private practice guys.

 

[Fastrach]

We are routinely putting those 14ga fire hoses in only for TAA repairs... not for ascending or thoracic aneurysms, not for thoracic endografts, strictly TAA's... do them under fluoro in the OR before going to sleep, generally no more complicated than putting in an epidural, and in many ways a lot easier.

 

[drccw]

Ahh the good ole lumbar drain...

place a good number in residency... only a handful since I've been in private practice....

I'm not a huge fan... I think the data isn't great in terms of benefits but the risks are definitely well known... our neurosurgeons will ask us to place them though for the occasional posterior fossa procedure that they do...

At our hospital we do them awake, before induction- I know some people do them asleep but that's what the local trend was so that's what we do.. what I do love about putting them in is that it isn't like a spinal... you know if you're in.. it's not pull the stylet out and wait to see if CSF is coming..

 

[Arch Guillotti]

I did one maybe two of these during residency and damn I thought it was the coolest procedure EVER! Strictly for TAA stuff. For the life of me I can't remember if it was awake or asleep but I want to say asleep. I am not sure why you would do this under fluoro, CSF is a definitive endpoint.

The 14 gauge I used just seemed enormous, I think that they were so much fun becuase it was the only time I ever got to wet tap somebody on purpose.

 

[FlintTown]

At my residency we do them only for thoracoAAA's, whether open or EVAR. All done awake, but we do them immediately post-op (on sleepy patients) if it didn't function during the case.

can't say I've done any neuraxial/regional asleep except on kids.

 

[Trisomy13]

neurosurgery places them at my institution, and they are the only service i have heard that use them.


of course, the occasional L&D patient gets one accidentally.

 

[jwk]

We used to place sub-arachnoid epidural caths for drainage years ago, but only on intracranial procedures. I've never heard of using them during TAA repairs. Why are they used for these procedures?

 

[TheSandMan]

We used to place sub-arachnoid epidural caths for drainage years ago, but only on intracranial procedures. I've never heard of using them during TAA repairs. Why are they used for these procedures?

For spinal cord protection. With the cords blood supply threatened during these procedures, you can increase the CPP (cerebral perfusion pressure) by decreasing the ICP in the spinal canal (CPP = ABP - ICP). That being said, I've never done one myself.