优化腰硬联合麻醉技术的十大技巧(2013SOAP年会)

袁波

期待楼上的中文版。谢谢、
、、

未来神麻

mark，期待！

towin1982

回复 16# bird111


   期待你的中文翻译，:)

hawk8009

哭啊 听不懂啊呜

AAA5535

很期待，看看咱们到底和国际上有哪些区别？

lyong3288

好难啊 实在是天书

bird111

thank you very  much,i am appreciated.and well ,back to everybody  and this like home and i have been San Francisco since my collage day as my two sister live here and like all of you coming back to San Francisco is fun thing.epecically i am thankful of many of you are back here for this  particular meeting and it  is great to see many of you and see friends and new friend  here and other people as well.

the topic of  present of us  is gonna  to be an epidural and equinox .and certainly want to talk about --analysis(----分析）that how to use in growing and perhaps useful in this condition time  and time when a woman can not recieve a ---technic as we recognized that majority of the time can use ---technic and can make sure that is up to part and , does nothing and rare in  role
in terms of looking at epidural technic, ithink about it ,reason for  why i call this  equinox has a coupl of reasons:first ,if you look at the dictionary definition of the equinox ,we could note when sun crosses the ---equator(赤道），make a time a day equivelent to day and night  ,as you know here we are in the centric , we have to no deviation  through day and night and we have to able to do our technic at any appointed time and other reason i name it for song written by joln coltrance and what i like about Coltrane is he is a prominent musician in jazz at the time of his soaring (此处先生说的是：searing 我以为是口误，所以改下哈)popularity that is in 1960s to 1970s.reason he was promptly popular is that he had a real attention on his craft ,he is known  to take a  rift note which is a collection of forty notes ,sometimes he practiced himselft after four or five hours at a time ,moreover,he played the different type of  instruments to get the more varity of  different approach ,bacause of that  his attention is the way that we should look at our own technic and should be question based our own and we are gonna to ask yourself :if some of this innovation of things are what we have  been incorporated with ? some were capable with and some perhaps were we have to change our  incorporation into our practice,but once we decide to do that ,we need to practice,practice and practice
now ,you maybe familar with -- musical with--in 1959s.my favorite things are the --- tune that comes out of this and was  one of growing and surpopular tune comes out of that .it was the jone Coltranes favorite songs as well .in fact,he was known to take this one song and take forty-five measures to reflect the voice and he played and played and take about forty minutes and he was known to take this one song and sometimes he only played this one song for entire concert.he was also recorded eigteen different albums and is able to be sort of profession statement and similarly,i think we have our favorite ways in doing things and sometimes thing need to be challenged ,reexamined and incorporated

bird111

one of them is certain patient positioning and by showing hands, so i could see how many people by large set patients up while doing the placement .ok,wide majority there.now ,there are maybe some advantages to setting the patient uprightly, but there could be advantage to lateral position as well and has a part in patient movement .there are a number of studys that look at connectic motion of woman in pregnancy,even fully pregnancy at forty weeks gestation.limitation in mvement by back and forward ;side to side,even rotational is only two to three precent and we have witnessed to install that position while we try to do placement and i know that .when you once is in the lateral position ,you actually  have secured  by bed  and you can not move back and forward because fixtion calls fitness bad and you can not move side to side because the bed is in the way .and overall thay can take a more relaxant posture and that posture non movement is certainlly helpful to us ,but there are some other reasons expecially an optional bilateral position is not avaliable and that he has a cord prolaps or if they have a fetal part  presenting. these are individuals you can not setting up

bird111

thank you very  much,i am appreciated.and well ,back to everybody  and this like home and i have been San Francisco since my collage day as my two sister live here and like all of you coming back to San Francisco is fun thing.epecically i am thankful of many of you are back here for this  particular meeting and it  is great to see many of you and see friends and new friend  here and other people as well.

the topic of  present of us  is gonna  to be an epidural and equinox .and certainly want to talk about --analysis(----分析）that how to use in growing and perhaps useful in this condition time  and time when a woman can not recieve a ---technic as we recognized that majority of the time can use ---technic and can make sure that is up to part and , does nothing and rare in  role
in terms of looking at epidural technic, ithink about it ,reason for  why i call this  equinox has a coupl of reasons:first ,if you look at the dictionary definition of the equinox ,we could note when sun crosses the ---equator(赤道），make a time a day equivelent to day and night  ,as you know here we are in the centric , we have to no deviation  through day and night and we have to able to do our technic at any appointed time and other reason i name it for song written by joln coltrance and what i like about Coltrane is he is a prominent musician in jazz at the time of his soaring (此处先生说的是：searing 我以为是口误，所以改下哈)popularity that is in 1960s to 1970s.reason he was promptly popular is that he had a real attention on his craft ,he is known  to take a  rift note which is a collection of forty notes ,sometimes he practiced himselft after four or five hours at a time ,moreover,he played the different type of  instruments to get the more varity of  different approach ,bacause of that  his attention is the way that we should look at our own technic and should be question based our own and we are gonna to ask yourself :if some of this innovation of things are what we have  been incorporated with ? some were capable with and some perhaps were we have to change our  incorporation into our practice,but once we decide to do that ,we need to practice,practice and practice
now ,you maybe familar with -- musical with--in 1959s.my favorite things are the --- tune that comes out of this and was  one of growing and surpopular tune comes out of that .it was the jone Coltranes favorite songs as well .in fact,he was known to take this one song and take forty-five measures to reflect the voice and he played and played and take about forty minutes and he was known to take this one song and sometimes he only played this one song for entire concert.he was also recorded eigteen different albums and is able to be sort of profession statement and similarly,i think we have our favorite ways in doing things and sometimes thing need to be challenged ,reexamined and incorporated .one of them is certain patient positioning and by showing hands, so i could see how many people by large set patients up while doing the placement .ok,wide majority there.now ,there are maybe some advantages to setting the patient uprightly, but there could be advantage to lateral position as well and has a part in patient movement .there are a number of studys that look at connectic motion of woman in pregnancy,even fully pregnancy at forty weeks gestation.limitation in mvement by back and forward ;side to side,even rotational is only two to three precent and we have witnessed to install that position while we try to do placement and i know that .when you once is in the lateral position ,you actually  have secured  by bed  and you can not move back and forward because fixtion calls fitness bad and you can not move side to side because the bed is in the way .and overall thay can take a more relaxant posture and that posture non movement is certainlly helpful to us ,but there are some other reasons expecially an optional bilateral position is not avaliable and that he has a cord prolaps or if they have a fetal part  presenting. these are individuals you can not setting up.

bird111

as i said your labour analgesia would actually move onto another type of analgesia,you are gonna to inform not for the delivery or you will commit the patient to the general anesthesia.so if you can not do your technic in lateral position and if you get confronted with that technic and now there would be something that adds your amendment terms ,and there are other advantages in lateral position as well.Bahar illustrate this rank to mark nine hundred patient to either exited a lateral or a lateral ten degree trendonburgar position and what he found

bird111

thank you very  much,i am appreciated.and well ,back to everybody  and this like home and i have been San Francisco since my collage day as my two sister live here and like all of you coming back to San Francisco is fun thing.epecically i am thankful of many of you are back here for this  particular meeting and it  is great to see many of you and see friends and new friend  here and other people as well.

the topic of  present of us  is gonna  to be an epidural and equinox .and certainly want to talk about --analysis(----分析）that how to use in growing and perhaps useful in this condition time  and time when a woman can not recieve a ---technic as we recognized that majority of the time can use ---technic and can make sure that is up to part and , does nothing and rare in  role
in terms of looking at epidural technic, ithink about it ,reason for  why i call this  equinox has a coupl of reasons:first ,if you look at the dictionary definition of the equinox ,we could note when sun crosses the ---equator(赤道），make a time a day equivelent to day and night  ,as you know here we are in the centric , we have to no deviation  through day and night and we have to able to do our technic at any appointed time and other reason i name it for song written by joln coltrance and what i like about Coltrane is he is a prominent musician in jazz at the time of his soaring (此处先生说的是：searing 我以为是口误，所以改下哈)popularity that is in 1960s to 1970s.reason he was promptly popular is that he had a real attention on his craft ,he is known  to take a  rift note which is a collection of forty notes ,sometimes he practiced himselft after four or five hours at a time ,moreover,he played the different type of  instruments to get the more varity of  different approach ,bacause of that  his attention is the way that we should look at our own technic and should be question based our own and we are gonna to ask yourself :if some of this innovation of things are what we have  been incorporated with ? some were capable with and some perhaps were we have to change our  incorporation into our practice,but once we decide to do that ,we need to practice,practice and practice
now ,you maybe familar with -- musical with--in 1959s.my favorite things are the --- tune that comes out of this and was  one of growing and surpopular tune comes out of that .it was the jone Coltranes favorite songs as well .in fact,he was known to take this one song and take forty-five measures to reflect the voice and he played and played and take about forty minutes and he was known to take this one song and sometimes he only played this one song for entire concert.he was also recorded eigteen different albums and is able to be sort of profession statement and similarly,i think we have our favorite ways in doing things and sometimes thing need to be challenged ,reexamined and incorporated .one of them is certain patient positioning and by showing hands, so i could see how many people by large set patients up while doing the placement .ok,wide majority there.now ,there are maybe some advantages to setting the patient uprightly, but there could be advantage to lateral position as well and has a part in patient movement .there are a number of studys that look at connectic motion of woman in pregnancy,even fully pregnancy at forty weeks gestation.limitation in mvement by back and forward ;side to side,even rotational is only two to three precent and we have witnessed to install that position while we try to do placement and i know that .when you once is in the lateral position ,you actually  have secured  by bed  and you can not move back and forward because fixtion calls fitness bad and you can not move side to side because the bed is in the way .and overall thay can take a more relaxant posture and that posture non movement is certainlly helpful to us ,but there are some other reasons expecially an optional bilateral position is not avaliable and that he has a cord prolaps or if they have a fetal part  presenting. these are individuals you can not setting up. as i said your labour analgesia would actually move onto another type of analgesia,you are gonna to inform not for the delivery or you will commit the patient to the general anesthesia.so if you can not do your technic in lateral position and if you get confronted with that technic and now there would be something that adds your amendment terms ,and there are other advantages in lateral position as well.Bahar illustrate this rank to mark nine hundred patient to either exited a lateral or a lateral ten degree trendonburgar position and what he found

bird111

in the lateral trendonnurgar position but the just lateral position,the blood in the needle was less and blood in the catheter was less and you may think this is only for normal size individual and he also rank to mark four hundred and fifty patients behind the mark to the same three position and found that this advantage was trendonburgar position or just lateral position in the term of blood in the catheter here and overall correlated with he takes both studys together is less overall attempts because of  less need of catheter replacement while performing in lateral space .but how does it makes sense ? Igarashi provides some answers to that ,and what Igarashi did is taking a fiberoscope(光导纤维镜）and thread it into an epidural needle(硬膜外穿刺针），he take first the individual in non pregnant state and examine her epidual space and found that the vein collateral system was diminished ,small and natural and nothing prevents the intrusion of catheter or needle;but take this individual at twelve weeks of pregnancy and you will find they will be further engorgement of vein system and you find when she gets to full term and it will have engorgement and further crudement of the vein collateral system in the epidural space.the epidural system is valveless and does not present any sort of barrier to change hydrodynamac pressure.so if we send them a collum of fluid up ,it will translocate to the bottom of element and that is the channel and that would be the lumbar section (腰椎部）where operating your catheter and needle。

bird111

thank you very  much,i am appreciated.and well ,back to everybody  and this like home and i have been San Francisco since my collage day as my two sister live here and like all of you coming back to San Francisco is fun thing.epecically i am thankful of many of you are back here for this  particular meeting and it  is great to see many of you and see friends and new friend  here and other people as well.

the topic of  present of us  is gonna  to be an epidural and equinox .and certainly want to talk about --analysis(----分析）that how to use in growing and perhaps useful in this condition time  and time when a woman can not recieve a ---technic as we recognized that majority of the time can use ---technic and can make sure that is up to part and , does nothing and rare in  role
in terms of looking at epidural technic, ithink about it ,reason for  why i call this  equinox has a coupl of reasons:first ,if you look at the dictionary definition of the equinox ,we could note when sun crosses the ---equator(赤道），make a time a day equivelent to day and night  ,as you know here we are in the centric , we have to no deviation  through day and night and we have to able to do our technic at any appointed time and other reason i name it for song written by joln coltrance and what i like about Coltrane is he is a prominent musician in jazz at the time of his soaring (此处先生说的是：searing 我以为是口误，所以改下哈)popularity that is in 1960s to 1970s.reason he was promptly popular is that he had a real attention on his craft ,he is known  to take a  rift note which is a collection of forty notes ,sometimes he practiced himselft after four or five hours at a time ,moreover,he played the different type of  instruments to get the more varity of  different approach ,bacause of that  his attention is the way that we should look at our own technic and should be question based our own and we are gonna to ask yourself :if some of this innovation of things are what we have  been incorporated with ? some were capable with and some perhaps were we have to change our  incorporation into our practice,but once we decide to do that ,we need to practice,practice and practice
now ,you maybe familar with -- musical with--in 1959s.my favorite things are the --- tune that comes out of this and was  one of growing and surpopular tune comes out of that .it was the jone Coltranes favorite songs as well .in fact,he was known to take this one song and take forty-five measures to reflect the voice and he played and played and take about forty minutes and he was known to take this one song and sometimes he only played this one song for entire concert.he was also recorded eigteen different albums and is able to be sort of profession statement and similarly,i think we have our favorite ways in doing things and sometimes thing need to be challenged ,reexamined and incorporated .one of them is certain patient positioning and by showing hands, so i could see how many people by large set patients up while doing the placement .ok,wide majority there.now ,there are maybe some advantages to setting the patient uprightly, but there could be advantage to lateral position as well and has a part in patient movement .there are a number of studys that look at connectic motion of woman in pregnancy,even fully pregnancy at forty weeks gestation.limitation in mvement by back and forward ;side to side,even rotational is only two to three precent and we have witnessed to install that position while we try to do placement and i know that .when you once is in the lateral position ,you actually  have secured  by bed  and you can not move back and forward because fixtion calls fitness bad and you can not move side to side because the bed is in the way .and overall thay can take a more relaxant posture and that posture non movement is certainlly helpful to us ,but there are some other reasons expecially an optional bilateral position is not avaliable and that he has a cord prolaps or if they have a fetal part  presenting. these are individuals you can not setting up. as i said your labour analgesia would actually move onto another type of analgesia,you are gonna to inform not for the delivery or you will commit the patient to the general anesthesia.so if you can not do your technic in lateral position and if you get confronted with that technic and now there would be something that adds your amendment terms ,and there are other advantages in lateral position as well.Bahar illustrate this rank to mark nine hundred patient to either exited a lateral or a lateral ten degree trendonburgar position and what he found in the lateral trendonnurgar position but the just lateral position,the blood in the needle was less and blood in the catheter was less and you may think this is only for normal size individual and he also rank to mark four hundred and fifty patients behind the mark to the same three position and found that this advantage was trendonburgar position or just lateral position in the term of blood in the catheter here and overall correlated with he takes both studys together is less overall attempts because of  less need of catheter replacement while performing in lateral space .but how does it makes sense ? Igarashi provides some answers to that ,and what Igarashi did is taking a fiberoscope(光导纤维镜）and thread it into an epidural needle(硬膜外穿刺针），he take first the individual in non pregnant state and examine her epidual space and found that the vein collateral system was diminished ,small and natural and nothing prevents the intrusion of catheter or needle;but take this individual at twelve weeks of pregnancy and you will find they will be further engorgement of vein system and you find when she gets to full term and it will have engorgement and further crudement of the vein collateral system in the epidural space.the epidural system is valveless and does not present any sort of barrier to change hydrodynamac pressure.so if we send them a collum of fluid up ,it will translocate to the bottom of element and that is the channel and that would be the lumbar section (腰椎部）where operating your catheter and needle。

bird111

so consideration for the lateral  approach.how about the epidural needl placement ?we think about this just bevel of needle makes a difference ,turning the face of cephalad of the epidural  right,perhaps caught that is one beter than other .and this is the question  that addressed by huffnagle sj.basically what he did is that randomizing(随机分配） a hundred and sixty patients into forty age groups to either have the beleve faced cephalad(头向）left or right caudad(尾向）and what he found was that cephalad orientation has less number of one side of block , less number of inadequate block and also greatest number of puncture with comfort ,so this cephalad orientation is benefitful and now what is interesting is gonna to beaming in a couple of what orthepedics（骨科）papers have derived some information from this .that is saying if you are coming in for left knee replacement that some individual are actually turning the bevel of needl of epidural technic to the left side and this orthepedic papers also suggest you will have better block coverage on affected or surgical side and what the patient would not want that

bird111

thank you very  much,i am appreciated.and well ,back to everybody  and this like home and i have been San Francisco since my collage day as my two sister live here and like all of you coming back to San Francisco is fun thing.epecically i am thankful of many of you are back here for this  particular meeting and it  is great to see many of you and see friends and new friend  here and other people as well.

the topic of  present of us  is gonna  to be an epidural and equinox .and certainly want to talk about --analysis(----分析）that how to use in growing and perhaps useful in this condition time  and time when a woman can not recieve a ---technic as we recognized that majority of the time can use ---technic and can make sure that is up to part and , does nothing and rare in  role
in terms of looking at epidural technic, ithink about it ,reason for  why i call this  equinox has a coupl of reasons:first ,if you look at the dictionary definition of the equinox ,we could note when sun crosses the ---equator(赤道），make a time a day equivelent to day and night  ,as you know here we are in the centric , we have to no deviation  through day and night and we have to able to do our technic at any appointed time and other reason i name it for song written by joln coltrance and what i like about Coltrane is he is a prominent musician in jazz at the time of his soaring (此处先生说的是：searing 我以为是口误，所以改下哈)popularity that is in 1960s to 1970s.reason he was promptly popular is that he had a real attention on his craft ,he is known  to take a  rift note which is a collection of forty notes ,sometimes he practiced himselft after four or five hours at a time ,moreover,he played the different type of  instruments to get the more varity of  different approach ,bacause of that  his attention is the way that we should look at our own technic and should be question based our own and we are gonna to ask yourself :if some of this innovation of things are what we have  been incorporated with ? some were capable with and some perhaps were we have to change our  incorporation into our practice,but once we decide to do that ,we need to practice,practice and practice
now ,you maybe familar with -- musical with--in 1959s.my favorite things are the --- tune that comes out of this and was  one of growing and surpopular tune comes out of that .it was the jone Coltranes favorite songs as well .in fact,he was known to take this one song and take forty-five measures to reflect the voice and he played and played and take about forty minutes and he was known to take this one song and sometimes he only played this one song for entire concert.he was also recorded eigteen different albums and is able to be sort of profession statement and similarly,i think we have our favorite ways in doing things and sometimes thing need to be challenged ,reexamined and incorporated .one of them is certain patient positioning and by showing hands, so i could see how many people by large set patients up while doing the placement .ok,wide majority there.now ,there are maybe some advantages to setting the patient uprightly, but there could be advantage to lateral position as well and has a part in patient movement .there are a number of studys that look at connectic motion of woman in pregnancy,even fully pregnancy at forty weeks gestation.limitation in mvement by back and forward ;side to side,even rotational is only two to three precent and we have witnessed to install that position while we try to do placement and i know that .when you once is in the lateral position ,you actually  have secured  by bed  and you can not move back and forward because fixtion calls fitness bad and you can not move side to side because the bed is in the way .and overall thay can take a more relaxant posture and that posture non movement is certainlly helpful to us ,but there are some other reasons expecially an optional bilateral position is not avaliable and that he has a cord prolaps or if they have a fetal part  presenting. these are individuals you can not setting up. as i said your labour analgesia would actually move onto another type of analgesia,you are gonna to inform not for the delivery or you will commit the patient to the general anesthesia.so if you can not do your technic in lateral position and if you get confronted with that technic and now there would be something that adds your amendment terms ,and there are other advantages in lateral position as well.Bahar illustrate this rank to mark nine hundred patient to either exited a lateral or a lateral ten degree trendonburgar position and what he found in the lateral trendonnurgar position but the just lateral position,the blood in the needle was less and blood in the catheter was less and you may think this is only for normal size individual and he also rank to mark four hundred and fifty patients behind the mark to the same three position and found that this advantage was trendonburgar position or just lateral position in the term of blood in the catheter here and overall correlated with he takes both studys together is less overall attempts because of  less need of catheter replacement while performing in lateral space .but how does it makes sense ? Igarashi provides some answers to that ,and what Igarashi did is taking a fiberoscope(光导纤维镜）and thread it into an epidural needle(硬膜外穿刺针），he take first the individual in non pregnant state and examine her epidual space and found that the vein collateral system was diminished ,small and natural and nothing prevents the intrusion of catheter or needle;but take this individual at twelve weeks of pregnancy and you will find they will be further engorgement of vein system and you find when she gets to full term and it will have engorgement and further crudement of the vein collateral system in the epidural space.the epidural system is valveless and does not present any sort of barrier to change hydrodynamac pressure.so if we send them a collum of fluid up ,it will translocate to the bottom of element and that is the channel and that would be the lumbar section (腰椎部）where operating your catheter and needle。so consideration for the lateral  approach.how about the epidural needl placement ?we think about this just bevel of needle makes a difference ,turning the face of cephalad of the epidural  right,perhaps caught that is one beter than other .and this is the question  that addressed by huffnagle sj.basically what he did is that randomizing(随机分配） a hundred and sixty patients into forty age groups to either have the beleve faced cephalad(头向）left or right caudad(尾向）and what he found was that cephalad orientation has less number of one side of block , less number of inadequate block and also greatest number of puncture with comfort ,so this cephalad orientation is benefitful and now what is interesting is gonna to beaming in a couple of what orthepedics（骨科）papers have derived some information from this .that is saying if you are coming in for left knee replacement that some individual are actually turning the bevel of needl of epidural technic to the left side and this orthepedic papers also suggest you will have better block coverage on affected or surgical side and what the patient would not want that