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[Thoracic epidural anesthesia by the caudal route in pediatric anesthesia: age is a limiting factor]
D Blanco1, J Llamazares, J Martínez-Mora
1Servico de Anestesiología Reanimación y Terapia del Dolor, Hospital Universitario de Badalona Germans Trias i Pujol, Barcelona.
Insights
Caudal epidural catheter placement to T10 in children is unreliable, especially in those over one year old. Easy insertion does not guarantee successful catheter positioning for pediatric anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Regional Anesthesia
Background:
- Caudal epidural anesthesia is common in pediatric patients.
- Accurate catheter placement is crucial for effective anesthesia and to avoid complications.
Purpose of the Study:
- To assess the success rate and difficulty of placing an epidural catheter in the caudal space to reach the T10 level in young patients.
- To determine if ease of insertion correlates with successful catheter placement.
Main Methods:
- Forty-seven children (up to 97 months) underwent caudal epidural catheterization under general anesthesia.
- An 18-gauge epidural catheter was advanced to a predetermined length aiming for T10.
- Postoperative X-rays with contrast confirmed catheter tip location; placement was classified as easy, difficult, or impossible.
Main Results:
- Only 16% of catheters were successfully placed between T10-T12.
- Success rates were higher in infants under 1 year (52%) compared to older children (17%).
- The L4-L5 epidural space was the most common final position (46/47), and easy advancement did not predict successful T10-T12 placement.
Conclusions:
- Caudal epidural catheter insertion does not reliably achieve thoracic epidural space placement (T10) in pediatric patients.
- The success rate significantly decreases in children over one year of age.
- Easy catheter advancement is not a reliable indicator of successful thoracic epidural placement.
Objectives:
To evaluate the success and degree of difficulty of inserting an epidural catheter into the caudal space in order to place its distal end at T10 in young patients.
Patients And Methods:
Forty-seven children up to 97 months old were studied. With the patients under general anesthesia with an orotracheal tube, a predetermined length of 18-G epidural catheter (Minipack: SYSTEM 2-Portex) was inserted to T10. X-rays were taken after surgery with 0.3 ml of iodine contrast. The catheter was considered well-placed if the distal end was between T10-T12; the approach was classified as easy, difficult or impossible.
Results:
The catheter was placed at T12-T10 on 16 occasions: 6 in L1, 3 in L2, 4 in L3, 17 in L4-L5, and 1 in S1. T10-T12 was reached in 52% of patients under 1 year of age, but in only 17% of children older than 1 year. The L4-L5 epidural space was reached with 46 of 47 catheters. Advance was easy in 41 cases, with only 16 reaching the objective. Advance was difficult in 6 cases, with only 1 reaching L1 and none reaching T10-T12. All catheters were easily removed.
Conclusions:
It is not possible to guarantee the arrival of an 18-G epidural catheter to the thoracic epidural space by entering through the caudal route. In children over 1 year of age, the level of success decreases significantly. Easy advance of the catheter cannot be taken to be a sign of success.