“Whoosh” Test as a Teaching Aid in Caudal Block

Abstract

Fifty-three patients presenting for minor gynaecological procedures received caudal blocks performed by residents. These residents used the standard technique which relied on the "give" felt as a needle penetrates the sacrococcygeal membrane and the loss of resistance to air when the needle is correctly placed. The "whoosh" test was noted by the supervising anaesthetist who did not reveal his findings to the residents. A positive test consisted of a characteristic "whoosh" sound on auscultation of the thoracolumbar region when 2 to 3 ml of air was injected into the caudal extradural space. The predictive value of a positive test was found to be 78%, 80.7% and 97.7% (P< 0.01) for a positive "give'; loss of resistance and "whoosh" test respectively. Negative tests had no predictive value for "give" and loss of resistance whilst the predictive value of an absent "whoosh" was 100% (P< 0.05). Thus we conclude that the "whoosh" test is an excellent aid in the teaching of caudal anaesthesia.

Comparison of ‘whoosh’ and modified ‘swoosh’ test for identification of the caudal epidural space in children

“…The sensitivity, specificity and positive predictive value of the ‘whoosh’ test was comparable with the clinical predictors and was found to be 100% in our study. This was in contrast to the studies of Chan et al (2) and Eastwood et al (9) both of which found the ‘whoosh’ to be superior to clinical impression of caudal placement. Both these studies were however carried out in adult patients.…”

“…The ‘whoosh’ test was first described by Lee in 1988 (8) and the value of the test was confirmed by Lewis et al in 1992 (1). Chan et al (2) demonstrated that the predictive value of a positive ‘whoosh’ (97.7%) was much higher than that of a positive ‘give’ (78%) and loss of resistance (80.7%). Negative tests had no predictive value for ‘give’ and loss of resistance whereas the predictive value of an absent ‘whoosh’ was 100%.…”

“…The ‘whoosh’ test, first described by Lewis et al in 1992 (1) is a simple and effective method to confirm correct placement of the needle in the caudal space. It is reported to be more reliable than loss of resistance and the ‘give’ felt on piercing the sacrococcygeal membrane, both of which are subjective endpoints (2).…”

Total spinal anaesthesia following caudal block with bupivacaine and buprenorphine

“…Aspiration test, once the needle has been inserted in the epidural space is recommended by most authors (1). A 'Whoosh test' has also been recommended as a reliable method to check the correct placement of the needle in the extradural caudal space (11,12). In a recent retrospective multicentre study of the complications of regional anaesthesia in children, four out of five serious accidents reported had the epidural space localized with loss of resistance technique with air.…”

A comparison of the effectiveness of predictors of caudal block in children-swoosh test, anal sphincter tone, and heart rate response

“…It has been studied as a safer alternative to the original “whoosh” test where injection of air into the epidural space produced an audible whoosh on auscultation. [17] Our study showed a sensitivity of 66.51% and a specificity of 35.71% for the swoosh test.…”