Combined Spinal Epidural Catheters for Epidural Cooling, Cerebrospinal Fluid Aspiration and Spinal Intralipid Infusion for Treatment of Spinal and Brain Injuries, Diseases and Protection


A new proposal for spinal cord and brain treatment and protection due to injuries and diseases is made herein. It is composed of two 20G nylon catheters with 6 lateral holes arranged circumferentially within 3 cm from the tip and a closed end. One catheter is inserted into the epidural space and the other catheter is inserted into the spinal space in two different lumbar interspaces using an 18G Tuohy needle 90 mm. The epidural catheter is used for cooled saline injection and infusion. The spinal catheter is used for Intralipid spinal injections and CSF aspiration. The proposal is based on the current studies on spinal cord cooling and CSF aspiration as well as on the Intralipid resuscitation properties and lipid brain protection. A study is needed to evaluate the clinical value of this combined approach.

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J. Eldor, "Combined Spinal Epidural Catheters for Epidural Cooling, Cerebrospinal Fluid Aspiration and Spinal Intralipid Infusion for Treatment of Spinal and Brain Injuries, Diseases and Protection," Open Journal of Anesthesiology, Vol. 4 No. 1, 2014, pp. 13-30. doi: 10.4236/ojanes.2014.41003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Y. M. Wang, “Compositions and Treatment Method for Brain and Spinal Cord Injuries,” Patent No. US 6683066 B2, 2004.
[2] S. W. Hoffman, A. L. Kellermann, D. G. Stein, D. W. Wright and D. W. Lowery-North, “Dosage Regimen for the Treatment of a Traumatic Brain Injury with Progesterone,” Patent No. EP 1868614 A2, 2007.
[3] M. Eisenbach-Schwartz, E. Yoles and E. Hauben, “Use of Poly-Glu, Tyr for Neuroprotection Therapy of the Cns or Pns,” Patent No. EP 1406650 B1, 2008.
[4] J. Whyte and M. Rosenthal, “Rehabilitation of the Patient with Traumatic Brain Injury,” In: J. A. DeLisa, Ed., Rehabilitation Medicine: Principles and Practice, 2nd Edition, Lippincott, Philadelphia, 1993, pp. 825-860.
[5] R. F. Frankowski, J. F. Annegers and S. Whitman, “The Descriptive Epidemiology of Head Trauma in the United States,” In: D. P. Becker and J. T. Povlishock, Eds., Central Nervous System Research Status Report, NINCDS; Bethesda, 1985, pp. 33-43.
[6] M. E. Sandel and M. Finch, “The Case for Comprehensive Residency Training in Traumatic Brain Injury: A Commentary,” American Journal of Physical Medicine & Rehabilitation, Vol. 72, No. 5, 1993, pp. 325-326.
[7] B. Jennett and M. Bond, “Assessment of Outcome in Severe Brain Damage,” The Lancet, Vol. 305, No. 7905, 1975, pp. 480-484.
[8] J. F. Kraus and D. L. McArthur, “Epidemiologic Aspects of Brain Injury,” Neurologic Clinics, Vol. 14, No. 2, 1996, pp. 435-450.
[9] W. Max, E. J. Mackenzie and D. P. Rice, “Head Injuries: Costs and Consequences,” Journal of Head Trauma Rehabilitation, Vol. 6, No. 2, 1991, pp. 76-91.
[10] W. R. McMordie and S. L. Barker, “The Financial Trauma of Head Injury,” Brain Injury, Vol. 2, No. 4, 1988, pp. 357-364.
[11] M. R. Bullock, B. G. Lyeth and J. P. Muizelaar, “Current Status of Neuroprotection Trials for Traumatic Brain Injury: Lessons from Animal Models and Clinical Studies,” Neurosurgery, Vol. 45, No. 2, 1999, pp. 207-217.
[12] L. D. Lehmkuhl, K. M. Hall, N. Mann and W. A. Gordon, “Factors That Influence Costs and Length of Stay of Persons with Traumatic Brain Injury in Acute Care and Inpatient Rehabilitation,” Journal of Head Trauma Rehabilitation, Vol. 8, No. 2, 1993, pp. 88-100.
[13] M. Bennett, D. P. OBrien, J. P. Phillips and M. A. Farrell, “Clinicopathologic Observations in 100 Consecutive Patients with Fatal Head Injury Admitted to a Neurosurgical Unit,” Irish Medical Journal, Vol. 88, No. 2, 1995, pp. 60-62.
[14] J. M. Meythaler and J. Peduzzi, “Method of Treating Traumatic Brain and Spinal Cord Injuries and Other Neurogenic Conditions Using Non-Steroidal Anti-Inflammatory Drugs and Naturally Occurring Conotoxins,” Patent No. EP 1210100 A4, 2004.
[15] F. Odaibo, C. A. Fajardo and C. Cronin, “Recovery of Intralipid from Lumbar Puncture after Migration of Saphenous Vein Catheter,” Archives of Disease in Childhood, Vol. 67, No. 10, 1992, pp. 1201-1203.
[16] Y. Koga, N. Iwatsuki, M. Takahashi and Y. Hashimoto, “Intralipid Solution Mistakenly Infused into Epidural Space,” Anesthesia & Analgesia, Vol. 71, No. 6, 1990, pp. 712-713.
[17] R. A. Stevens and N. Jorgensen, “Successful Treatment of Dural Puncture Headache with Epidural Saline Infusion after Failure of Epidural Blood Patch. Case Report,” Acta Anaesthesiologica Scandinavica, Vol. 32, No. 5, 1988, pp. 429-431.
[18] D. K. Turnbull and D. B. Shepherd, “Post-Dural Puncture Headache: Pathogenesis, Prevention and Treatment,” British Journal of Anaesthesia, Vol. 91, No. 5, 2003, pp. 718-729.
[19] R. M. A. Moomiaie, J. Ransden, J. Stein, J. Strugar, Q. B. Zhu, J. H. Kim and J. A. Elefteriades, “Cooling Catheter for Spinal Cord Preservation in Thoracic Aortic Surgery,” The Journal of Cardiovascular Surgery, Vol. 48, No. 1, 2007, pp. 103-108.
[20] Y. Okita, “Fighting Spinal Cord Complication during Surgery for Thoracoabdominal Aortic Disease,” General Thoracic and Cardiovascular Surgery, Vol. 59, No. 2, 2011, pp. 79-90.
[21] J. D. Galla, “Regional Spinal Cord Cooling Using a Countercurrent Closed-Lumen Epidural Catheter. Invited Commentary,” The Annals of Thoracic Surgery, Vol. 80, No. 5, 2005, pp. 1833-1834.
[22] A. Mori, T. Ueda, T. Hachiya, N. Kabei, H. Okano, R. Yozu and T. Sasaki, “An Epidural Cooling Catheter Protects the Spinal Cord Against Ischemic Injury in Pigs,” The Annals of Thoracic Surgery, Vol. 80, No. 5, 2005, pp. 1829-1833.
[23] R. P. Cambria, J. K. Davison, S. Zannetti, G. L’Italien, D. C. Brewster, J. P. Gertler, A. C. Moncure, G. M. LaMuraglia and W. M. Abbott, “Clinical Experience with Epidural Cooling for Spinal Cord Protection during Thoracic and Thoracoabdominal Aneurysm Repair,” Journal of Vascular Surgery, Vol. 25, No. 2, 1997, pp. 234-241; Discussion 241-243.
[24] R. M. Moomiaie, J. Ransden, J. Stein, J. Strugar, Q. B. Zhu, J. H. Kim and J. A. Elefteriades, “Cooling Catheter for Spinal Cord Preservation in Thoracic Aortic Surgery,” The Journal of Cardiovascular Surgery (Torino), Vol. 48, No. 1, 2007, pp. 103-108.
[25] R. P. Salzano Jr., L. H. Ellison, P. F. Altonji, J. Richter and P. J. Deckers, “Regional Deep Hypothermia of the Spinal Cord Protects against Ischemic Injury during Thoracic Aortic Cross-Clamping,” The Annals of Thoracic Surgery, Vol. 57, No. 1, 1994, pp. 65-70; Discussion 71.
[26] K. Tabayashi, Y. Saiki, H. Kokubo, G. Takahashi, J. Akasaka, S. Yoshida, M. Hata, K. Niibori, M. Miura and T. Konnai, “Protection from Postischemic Spinal Cord Injury by Perfusion Cooling of the Epidural Space during Most or All of a Descending Thoracic or Thoracoabdominal Aneurysm Repair,” General Thoracic and Cardiovascular Surgery, Vol. 58, No. 5, 2010, pp. 228-234.
[27] W. L. Breckwoldt, C. M. Genco, R. J. Connolly, R. J. Cleveland and J. T. Diehl, “Spinal Cord Protection during Aortic Occlusion: Efficacy of Intrathecal Tetracaine,” The Annals of Thoracic Surgery, Vol. 51, No. 6, 1991, pp. 959-963.
[28] J. L. Fox, E. N. Vu, M. Doyle-Waters, J. R. Brubacher, R. Abu-Laban and Z. Hu, “Prophylactic Hypothermia for Traumatic Brain Injury: A Quantitative Systematic Review,” CJEM, Vol. 12, No. 4, 2010, pp. 355-364.
[29] K. Peterson, S. Carson and N. Carney, “Hypothermia Treatment for Traumatic Brain Injury: A Systematic Review and Meta-Analysis,” Journal of Neurotrauma, Vol. 25, No. 1, 2008, pp. 62-71.
[30] N. G. Bazan, A. E. Musto and E. J. Knott, “Endogenous Signaling by Omega-3 Docosahexaenoic Acid-Derived Mediators Sustains Homeostatic Synaptic and Circuitry Integrity,” Molecular Neurobiology, Vol. 44, No. 2, 2011, pp. 216-222.
[31] R. Palacios-Pelaez, W. J. Lukiw and N. G. Bazan, “Omega-3 Essential Fatty Acids Modulate Initiation and Progression of Neurodegenerative Disease,” Molecular Neurobiology, Vol. 41, No. 2-3, 2010, pp. 367-374.
[32] C. Zhang and N. G. Bazan, “Lipid-Mediated Cell Signaling Protects against Injury and Neurodegeneration,” The Journal of Nutrition, Vol. 140, No. 4, 2010, pp. 858-863.
[33] E. Maciá-Botejara, J. M. Morán-Penco, M. T. Espín-Jaime, F. Botello-Martínez, J. Salas-Martínez, M. J. Caballero-Loscos and M. Molina-Fernández, “Brain Lipid Composition in Rabbits after Total Parenteral Nutrition with Two Different Lipid Emulsions,” Nutrition, Vol. 29, No. 1, 2013, pp. 313-317.
[34] A. M. Grunbaum, B. M. Gilfix, S. Gosselin and D. W. Blank, “Analytical Interferences Resulting from Intravenous Lipid Emulsion,” Clinical Toxicology (Phila), Vol. 50, No. 9, 2012, pp. 812-817.
[35] J. Li, A. Iorga, S. Sharma, J. Y. Youn, R. Partow-Navid, S. Umar, H. Cai, S. Rahman and M. Eghbali, “Intralipid, a Clinically Safe Compound, Protects the Heart against Ischemia-Reperfusion Injury More Efficiently than Cyclosporine-A,” Anesthesiology, Vol. 117, No. 4, 2012, pp. 836-846.
[36] G. L. Weinberg, T. VadeBoncouer, G. A. Ramaraju, M. F. Garcia-Amaro and M. J. Cwik, “Pretreatment or Resuscitation with a Lipid Infusion Shifts the Dose-Response to Bupivacaine-Induced Asystole in Rats,” Anesthesiology, Vol. 88, No. 4, 1998, pp. 1071-1075.
[37] G. L. Weinberg, R. Ripper, P. Murphy, L. B. Edelman, W. Hoffman, G. Strichartz and D. L. Feinstein, “Lipid Infusion Accelerates Removal of Bupivacaine and Recovery from Bupivacaine Toxicity in the Isolated Rat Heart,” Regional Anesthesia and Pain Medicine, Vol. 31, No. 4, 2006, pp. 296-303.
[38] G. Weinberg, R. Ripper, D. L. Feinstein and W. Hoffman, “Lipid Emulsion Infusion Rescues Dogs from Bupivacaine-Induced Cardiac Toxicity,” Regional Anesthesia and Pain Medicine, Vol. 28, No. 3, 2003, pp. 198-202.
[39] C. Jamaty, B. Bailey, A. Larocque, E. Notebaert, K. Sanogo and J. M. Chauny, “Lipid Emulsions in the Treatment of Acute Poisoning: A Systematic Review of Human and Animal Studies,” Clinical Toxicology (Phila), Vol. 48, No. 1, 2010, pp. 1-27.
[40] D. French, C. Smollin, W. Ruan, A. Wong, K. Drasner and A. H. Wu, “Partition Constant and Volume of Distribution as Predictors of Clinical Efficacy of Lipid Rescue for Toxicological Emergencies,” Clinical Toxicology (Phila), Vol. 49, No. 9, 2011, pp. 801-809.
[41] J. X. Mazoit, “Cardiac Arrest and Local Anaesthetics,” Presse Medicate, Vol. 42, No. 3, 2013, pp. 280-286.
[42] M. S. Blaber, J. N. Khan, J. A. Brebner and R. McColm, “‘Lipid Rescue’ for Tricyclic Antidepressant Cardiotoxicity,” The Journal of Emergency Medicine, Vol. 43, No. 3, 2012, pp. 465-467.
[43] A. Papadopoulou, J. W. Willers, T. L. Samuels and D. R. Uncles, “The Use of Dye Surrogates to Illustrate Local Anesthetic Drug Sequestration by Lipid Emulsion: A Visual Demonstration of the Lipid Sink Effect,” Regional Anesthesia & Pain Medicine, Vol. 37, No. 2, 2012, pp. 183-187.
[44] J. Mauch, O. M. Jurado, N. Spielmann, R. BettschartWolfensberger and M. Weiss, “Resuscitation Strategies from Bupivacaine-Induced Cardiac Arrest,” Pediatric Anesthesia, Vol. 22, No. 2, 2012, pp. 124-129.
[45] J. Mauch, O. M. Jurado, N. Spielmann, R. BettschartWolfensberger and M. Weiss, “Comparison of Epinephrine vs Lipid Rescue to Treat Severe Local Anesthetic Toxicity—An Experimental Study in Piglets,” Pediatric Anesthesia, Vol. 21, No. 11, 2011, pp. 1103-1108.
[46] V. Montiel, T. Gougnard and P. Hantson, “Diltiazem Poisoning Treated with Hyperinsulinemic Euglycemia Therapy and Intravenous Lipid Emulsion,” European Journal of Emergency Medicine, Vol. 18, No. 2, 2011, pp. 121-123.
[47] P. Hamann, P. I. Dargan, N. Parbat, H. Ovaska and D. M. Wood, “Availability of and Use of Intralipid (Lipid Rescue Therapy, Lipid Emulsion) in England and Wales,” Emergency Medicine Journal, Vol. 27, No. 8, 2010, pp. 590-592.
[48] P. L. West, N. J. McKeown and R. G. Hendrickson, “Iatrogenic Lipid Emulsion Overdose in a Case of Amlodipine Poisoning,” Clinical Toxicology (Phila), Vol. 48, No. 4, 2010, pp. 393-396.
[49] D. B. Hiller, G. Di Gregorio, K. Kelly, R. Ripper, L. Edelman, R. Boumendjel, K. Drasner and G. L. Weinberg, “Safety of High Volume Lipid Emulsion Infusion: A First Approximation of LD50 in Rats,” Regional Anesthesia & Pain Medicine, Vol. 35, No. 2, 2010, pp. 140-144.
[50] G. Cave and M. Harvey, “Intravenous Lipid Emulsion as Antidote beyond Local Anesthetic Toxicity: A Systematic Review,” Academic Emergency Medicine, Vol. 16, No. 9, 2009, pp. 815-824.
[51] M. Harvey and G. Cave, “Intralipid Outperforms Sodium Bicarbonate in a Rabbit Model of Clomipramine Toxicity,” Annals of Emergency Medicine, Vol. 49, No. 2, 2007, pp. 178-185.
[52] S. Umar, R. D. Nadadur, J. Li, F. Maltese, P. Partownavid, A. van der Laarse and M. Eghbali, “Intralipid Prevents and Rescues Fatal Pulmonary Arterial Hypertension and Right Ventricular Failure in Rats,” Hypertension, Vol. 58, No. 3, 2011, pp. 512-518.
[53] R. Krogh-Madsen, P. Plomgaard, T. Akerstrom, K. Moller, O. Schmitz and B. K. Pedersen, “Effect of Short-Term Intralipid Infusion on the Immune Response during Low-Dose Endotoxemia in Humans,” American Journal of Physiology—Endocrinology and Metabolism, Vol. 294, 2008, pp. E371-E379.
[54] K. L. Felice and H. M. Schumann, “Intravenous Lipid Emulsion for Local Anesthetic Toxicity: A Review of the Literature,” Journal of Medical Toxicology, Vol. 4, No. 3, 2008, pp. 184-191.

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