Dogliotti's principle

Dogliotti's principle is a principle in epidural anaesthesia first described by Professor Achille Mario Dogliotti in 1933.^[1] It is a method for the identification of the epidural space, a potential space. As a needle is advanced through the ligamentum flavum, to the epidural space, with constant pressure applied to the piston of a syringe, loss of resistance occurs once the needle enters the epidural space due to the change in pressure.^[2]^[3] The identification of this space, allows subsequent administration of epidural anaesthesia, a technique used primarily for analgesia during childbirth.^{[citation needed]}

This technique remains in use at present^[update], and is commonly referred to the loss of resistance to saline technique (LORS) or its variation, the loss of resistance to air technique (LORA). These use, respectively, saline or air to identify the epidural space. The LORS technique is generally favoured due to the increased complication risk with the LORA technique such as pneumocephalus or air embolism.^[3]^[4]^[5]

References

^ Dogliotti, AM (1933). "Research and clinical observations on spinal anesthesia: with special reference to the peridural technique" (PDF). Anesthesia & Analgesia. 12 (2): 59–65. doi:10.1213/00000539-193301000-00014. S2CID 70731119.
^ Iklé A (July 1950). "Preliminary report of new technique for epidural anaesthesia". British Journal of Anaesthesia. 22 (3): 150–5. doi:10.1093/bja/22.3.150. PMID 15426701.
^ ^a ^b Wilson MJA (2007). "Epidural endeavour and the pressure principle". Anaesthesia. 62 (4): 319–324. doi:10.1111/j.1365-2044.2007.05063.x. PMID 17381564.^{[dead link]}
^ Naulty JS, Ostheimer GW, Datta S, Knapp R, Weiss JB (November 1982). "Incidence of venous air embolism during epidural catheter insertion". Anesthesiology. 57 (5): 410–2. doi:10.1097/00000542-198211000-00010. PMID 7137620.
^ Simopoulos T, Peeters-Asdourian C (June 2001). "Pneumocephalus after cervical epidural steroid injection". Anesth. Analg. 92 (6): 1576–7. doi:10.1097/00000539-200106000-00045. PMID 11375849. S2CID 42001070.

[Dogliotti1933-1] Dogliotti, AM (1933). "Research and clinical observations on spinal anesthesia: with special reference to the peridural technique" (PDF). Anesthesia & Analgesia. 12 (2): 59–65. doi:10.1213/00000539-193301000-00014. S2CID 70731119.

[2] Iklé A (July 1950). "Preliminary report of new technique for epidural anaesthesia". British Journal of Anaesthesia. 22 (3): 150–5. doi:10.1093/bja/22.3.150. PMID 15426701.

[wilson-3] Wilson MJA (2007). "Epidural endeavour and the pressure principle". Anaesthesia. 62 (4): 319–324. doi:10.1111/j.1365-2044.2007.05063.x. PMID 17381564.^{[dead link]}

[4] Naulty JS, Ostheimer GW, Datta S, Knapp R, Weiss JB (November 1982). "Incidence of venous air embolism during epidural catheter insertion". Anesthesiology. 57 (5): 410–2. doi:10.1097/00000542-198211000-00010. PMID 7137620.

[5] Simopoulos T, Peeters-Asdourian C (June 2001). "Pneumocephalus after cervical epidural steroid injection". Anesth. Analg. 92 (6): 1576–7. doi:10.1097/00000539-200106000-00045. PMID 11375849. S2CID 42001070.

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v t e Anesthesia and anesthesiology
Types	General Sedation Procedural sedation and analgesia Twilight anesthesia Local Continuous wound infiltration Topical Neuraxial blockade Combined spinal and epidural anaesthesia Epidural anesthesia Spinal anaesthesia Nerve block Brachial plexus block Fascia iliaca block Femoral nerve block Inferior alveolar nerve block Intercostal nerve block Interpleural block Intravenous regional anesthesia Occipital nerve block Paracervical block Pudendal nerve block Retrobulbar block Sciatic nerve block Transverse abdominis plane block Total intravenous anaesthesia
Pharmacologic agents	Anticholinergics Antiemetics Butyrophenones Benzodiazepines General anesthetics Inhalational anesthetics Local anesthetics Neuromuscular-blocking drugs Opioids Sedatives
Techniques	Airway management Anesthesia provision in the US Bronchoscopy Dogliotti's principle Intravenous therapy Laryngoscopy Tracheal intubation Rapid sequence induction
Scientific principles	Blood–gas partition coefficient Concentration effect Fink effect Minimum alveolar concentration Second gas effect
Measurements	ASA physical status classification system Baricity Bispectral index Body mass index Capnography Entropy monitoring Fick principle Goldman index Guedel's classification Intraoperative neurophysiological monitoring Mallampati score Neuromuscular monitoring Pain scale Thyromental distance
Instruments	Anaesthetic machine Anesthetic vaporizer Arterial catheter Bronchial blocker Double-lumen endobronchial tube Gas cylinder Laryngeal mask airway Laryngeal tube Magill forceps Relative analgesia machine Tracheal tube
Complications	Allergic reactions Anesthesia awareness Drug-induced amnesia Effects of early-life exposures to anesthesia on the brain Emergence delirium Local anesthetic toxicity Malignant hyperthermia Perioperative mortality Postanesthetic shivering Postoperative nausea and vomiting Postoperative residual curarization
Subspecialties	Cardiothoracic Critical emergency medicine Geriatric Intensive care medicine Obstetric Oral sedation dentistry Pain medicine
Professions	Anesthesiologist Anesthesiologist assistant Nurse anesthetist Operating department practitioners Certified anesthesia technician Certified anesthesia technologist Anaesthetic technician Physicians' assistant (anaesthesia)
History	ACE mixture Helsinki Declaration for Patient Safety in Anaesthesiology History of general anesthesia History of neuraxial anesthesia History of tracheal intubation
Organizations	American Association of Nurse Anesthetists American Society of Anesthesia Technologists & Technicians American Society of Anesthesiologists Anaesthesia Trauma and Critical Care Association of Anaesthetists of Great Britain and Ireland Royal College of Anaesthetists Association of Veterinary Anaesthetists Australian and New Zealand College of Anaesthetists Australian Society of Anaesthetists International Anesthesia Research Society
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Dogliotti's principle

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