Te Mātauranga i ngā Āhua o ngā Tātai Pūnaha me ō rātou Whakamāhi

Ngā Whakamātautau o ngā Hōkio Pūnaha: Te Whakamātautau o te Tāwhai, o te Kōrero, me ngā Hāngā o te Stylet

Ngā Kōrero Whakamātautau vs. Ngā Kōrero Kāore i te Whakamātautau (Kōrero Āhua Pencil-Point) me te Whāia o te Riri i te Dura

Ko te whakamātautau o te tāwhai whakamātautau i ngā hōkio Quincke e whakamāhi ana i ngā kōrero dural, ā, ko tēnei e pāpā ana i ngā whāia o ngā riri dural me ngā rere o te wai cerebrospinal mai i te 25 ki te 40 ōrau i ngā whakamātautau o Anesthesiology i te tau 2022 i whakamāhi ai ngā hōkio kāore i te whakamātautau. I te rā anō, ko ngā kōrero āhua pencil-point pērā i ngā Whitacre, Sprotte rānei e mahi ana i tēnei wā i te whakapātai i ngā kōrero dural i te wāhi i te whakamātautau i aua kōrero. Ko tēnei e whakamāhi ana i ngā whakamātautau e tāwhai ana i te whakamātautau ake, ā, ko tēnei e whakamāhi ana i te whakamātautau o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā upoko o ngā up......

Te Āki o te Tāwhai, ngā tohu hō depth, me te tūtanga o te tāwhai mō te whakamārama o ngā whakamātautau

Ko ngā āhua o ngā papa kōkō i te wāhi kōkō, mai i ngā rākau āhua e 15 i te rākau āhua ki ngā rākau āhua e 30, he pai rawa hei whakamātautau i te hāere o te whakamātautau i te tāwhai o ngā rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau āhua i te rākau......

Te mahi o te stylet, te whakamārama o te hub, me te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama o te whakamārama......

Ko te stylet he rākau e mahi ana i āhua e rua ngā mahi nui i te whakamāhi i ngā whakamāhi: ka whakamātua te kōrero o te tīhanga i te wā o te whakamāhi i ngā rākau, ā, ka mau tonu te pūpū o roto i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā o te whakamāhi i te wā......

Ngā whakamātautau o ngā whakamātautau o ngā whakamātautau

Te whakamātautau i ngā rōpū matua o ngā kōhao pātai: Quincke, Whitacre, me Sprotte

Ngā tau o ngā kōhao CSF me ngā tau o ngā upoko pātai i muri i te pātai i te kōhao (PDPH) e whakamārama ana i te āhua o te mutunga

Ko te āhua o te whakamātautau o te rākau tāwhai te mea matua i te whakamārama i te upoko pāpā (PDPH) i muri i ngā whakamātautau i te kōrero, me ngā wāhi kōrero i te wāhi kōrero. Ko ngā rākau tāwhai Quincke tātai he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rākau tāwhai hou, he rāk......

Ngā whakamāngō o te whakaahua i te rere o te tāwhai hauāki me ngā whakamāngō ā-tātai i te whakamātau

Ko ngā whakamāngō o te whakaahua me ngā whakamāngō o te kaimahi e rerekē ana i te maha o ngā momo kōhao:

• Quincke : He whakamāngō kaha te 'pop' ā-tātai i te pā ki te dura, engari he whakamāngō hinga o ngā wāhi o te tāwhai hauāki i te rere o te āhua o te tapa kōmātua, he iti ake te whakaahua i te wā-ora.
• Whitacre : He whakamāngō ā-hauāki wātea, he whakamāngō ā-tātai hāngai—kāore he whakamāngō kaha kia māmā ai te pā ki ngā whānui, engari he whakamāngō ā-tātai anō hei whakamātau i te tikanga 'loss-of-resistance'.
• Sprotte : He whakamāngō ā-hauāki kua whakamātautau kia pai ake, he whakamāngō ā-tātai iti i te tapa tāwhai, ā, he whakamātautau kia māmā ai te whakaahua i te tāwhai hauāki, engari he iti ngā whakamāngō ā-tātai kia kitea ai te 'loss-of-resistance'.

Ko te whiriwhiri i te momo kōhao tika hei whakamāhua i te hāngai o ngā whakamātautau: ko ngā akoranga e whakaatu ana i te pakaru i te tau o ngā whakamāhua i te 30% ina hāngai ai te āhua o te kōhao ki te rākau whakaahua me ngā pūkenga o te kaimahi.

Te whiriwhiri i ngā kōhao whakamāhua e whai pūtake i ngā whakamātautau matua o te rongoā

Te whakamāhua i te kōpū me te anawētia i te kōpū: ngā tikanga whakamāhua i te rākau, te roa, me te whakamāhua i te tuarā

Ko ngā whakamātautau a te hapori mātai hauārai i tēnei wā e whakaae ana kia whakamahinga ngā whakamātautau āwhina (pencil point) kia rere kē mai i ngā whakamātautau āwhina (atraumatic) hei whakamātautau tino pai mō ngā whakamātautau lumbar punctures me ngā whakamātautau anasthesia spinal. Ko ngā whakamātautau ārahi e whakaatu ana ko ēnei whakamātautau e whakamāhi ana i ngā whakamātautau headache post-dural puncture i te haurua ki te toru hauwaru i te whakamāhi i ngā whakamātautau Quincke tūturu i runga i ngā whakamātautau ārahi katoa. I te whiriwhiri i te rākau o te whakamātautau, he whakamātautau mātua ō ngā kairangi i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau i te whakamāhi i te whakamātautau......

Ngā whakamātautau pūkenga: te tango i ngā oocytē, te taputapu toto epidural, me ngā taputapu ā-nerve

He hāngā pūkenga ngā whakamātautau:

• Te tango i ngā oocytē : E whakamāhi ana i ngā kōwhai 17G–19G me ngā whakamātautau ā-āhua me ngā pou tūtahi hei whakamāhi i te whakamātautau ā-tātai i te wā tonu i te tango i ngā follicle mai i te wāhi o te wāhine.
• Te taputapu toto epidural : E hiahiatia ana ngā kōwhai 18G Tuohy me ngā tohu mātauranga mātauranga me te whakamātautau kōrero kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamātautau kāore he whakamāta......
• Ngā taputapu ā-nerve o waho : E whakamāhi ana i ngā kōwhai 22G–25G me ngā whakamātautau mātua, ngā pou mātua hei whakamāhi i te whakamātautau ā-tātai me te whakamātautau ā-mātua i ngā wāhi pūkenga.

Ko te whakamāhi i ngā kōwhai e pai ana i ēnei whakamātautau he whakamāhi i ngā hāngā hāngā—ka tāpirihia ngā whakamātautau ā-tōpū, ngā whakamātautau ā-nerve, me ngā whakamātautau kāore he whakamātautau—i te 30–45% i te whakamāhi i ngā kōwhai kāore he whakamātautau, ā, i ngā whakamātautau ā-hāngā.

Ngā Pātai Tāpiri

He aha te tauira o ngā kōwhai ā-pencile i ngā kōwhai ā-kutanga?

Ngā rākau tāwhai pene, pērā i ngā rākau Whitacre me ngā rākau Sprotte, he nui te whakamāmā i ngā upoko pāpā (PDPH) i muri i te whakamātātutanga o te dura mā te whakamātātutanga i ngā kōhao o te dura i te wāhi i te tāwhai i aua kōhao.

He aha ngā take e hāngai ana i te āhua o te tapa o te rākau me te pūmau o te tinana o te rākau i te whakamātautau?

Ko te āhua o te tapa o te rākau me te pūmau o te tinana o te rākau e whāia ana ngā āhuatanga o te whakamātātutanga o ngā whānui, te whakamārama o te mahi, me te whakamārama o te whakamātātutanga. Ko ngā āhua i waenganui i ngā 15–30 ihirangi e whakamāmā ana i ēnei āhuatanga.

Me pēhea te whakamārama o te whakamātātutanga o te rākau i te whakamāhinga o te ultrasound?

Ko te ultrasound e whakamāmā ana i ngā rere o te whakamātātutanga mā te whakamāhinga i ngā whakaahua i te wāhanga, me te whakamārama o te whakamātātutanga i te wā o te whakamātātutanga, ā, he nui te whakamāmā i ngā whakamātātutanga me ngā raru o te mahi.

He aha ngā momo rākau e pai ana mo te whakamātātutanga o te lumbar me te whakamārama o te spinal?

Ko ngā rākau tāwhai pene e kore e whakamātātutia ngā whānui hei rākau e whakamāmā ana i ngā upoko pāpā (PDPH) me ngā raru o te whakamātātutanga o te CSF.

He aha ngā rākau ā-hāputanga e whakamāhinga ana mo te whakamātātutanga o ngā oocyte?

Ko te tango i ngā oocytē e whakamāhinga ana i ngā kōrere 17G–19G me ngā whakamātautau ā-huahua me ngā pou mātātū kia whakamāhinga ai te whakamātautau i te rere o ngā pūpū i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wāhi o te whakaahuatanga i te wā......