Epidurography in premature infants

Abstract

A caudal epidural catheter was inserted in 20 premature, high risk infants for abdominal or thoracic surgery under combined caudal epidural and general anaesthesia. Epidurography was used to confirm the position of the catheter which was found to be misplaced in three patients. The catheter penetrated the dura in one case, in another the tip was located in an epidural vessel and in the third the catheter was seen to be curled up within the epidural space. It was concluded that epidurographic control is essential with this method of anaesthesia in very small infants, in whom it was found to provide considerable advantages despite serious risks.

Prepuncture Ultrasound-Measured Distance: An Accurate Reflection of Epidural Depth in Infants and Small Children

“…15 Regarding epidural catheterization in infants and small children, the caudal route is historically preferred. 16,17 However, problems exist with this method; such as the catheter doubling back in small infants 18 and resistance to the passage of catheters caused by abutment on nerve roots. 15,16 When a catheter for controlling postoperative analgesia is necessary, a caudal approach may not be recommended because of an increased chance of urofecal contamination, especially in a small child.…”

Epidural and subarachnoid blockade in children

“…Epidural anaesthesia is of most benefit after major surgery associated with protracted and severe postoperative pain. Special indications include patients with respiratory disease and ex-premature infants [57]. Epidural anaesthesia may also be used as the sole anaesthetic for ex-premature infants undergoing surgery [58,59].…”

Progress in anesthesia and management of the newborn surgical patient

“…In a study of 20 infants with weights ranging between 520 and 2750 g using a smaller specially designed 23-guage neonatal catheter, there was a success rate of 85%, with malpositioned catheters ending up in epidural vessels, intrathecally and curled up in the lumbar space. 65 In this same study, 9 of the 20 infants were successfully extubated at the the end of the procedure.…”