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Epidurography in premature infants.
J van Niekerk1, B M Bax-Vermeire, J W Geurts
1Institute of Anaesthesiology, University Hospital for Children and Youth, Het Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands.
Anaesthesia
|September 1, 1990
Summary
Epidurography is essential for confirming caudal epidural catheter placement in premature infants undergoing surgery. This technique, while risky, offers significant advantages for anesthesia in high-risk neonates.
Area of Science:
- Pediatric Anesthesiology
- Neonatal Surgery
Background:
- Neonates, especially premature and high-risk infants, present unique challenges for surgical anesthesia.
- Combined caudal epidural and general anesthesia is utilized for abdominal or thoracic procedures in this population.
Purpose of the Study:
- To evaluate the efficacy and safety of caudal epidural catheter insertion in premature, high-risk infants.
- To determine the necessity of epidurography for accurate catheter placement.
Main Methods:
- A caudal epidural catheter was inserted in 20 premature, high-risk infants undergoing abdominal or thoracic surgery.
- Combined caudal epidural and general anesthesia was administered.
- Epidurography was employed to verify catheter position.
Main Results:
- Catheter placement was confirmed via epidurography in 17 out of 20 infants.
- Three cases (15%) showed misplaced catheters: dural penetration (1), epidural vessel placement (1), and catheter kinking (1).
Conclusions:
- Epidurographic control is crucial for ensuring correct caudal epidural catheter placement in very small infants.
- Despite potential risks, this anesthesia method offers substantial benefits for high-risk neonates.