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Loss of resistance to normal saline is preferred to identify the epidural space: a survey of Canadian pediatric anesthesiologists

[La perte de résistance au soluté physiologique est la technique préférée pour identifier l’espace péridural : une enquête auprès des anesthésiologistes pédiatriques canadiens]

From the Department of Anesthesia, Hospital for Sick Children, Toronto, Ontario, Canada.

Address correspondence to: Dr. Warwick A. Ames, Department of Anesthesia, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Phone: 416-813-8963; Fax: 416-813-7445; E-mail: wads{at}doctors.org.uk; ames0002{at}mc.duke.edu

Purpose: Several methods have been described to locate the epidural space, but the loss-of-resistance (LOR) technique is the most commonly used. Expert opinion states that LOR to air is the best medium for neonates and infants. We conducted a Canada-wide postal survey to determine the current state of practice for placement of epidural catheters in pediatric patients.

Methods: Two hundred and nine surveys were distributed to academic pediatric anesthesiologists across Canada. The survey was limited to six questions and was anonymous.

Results: The response rate was 62.2%. LOR was the method of choice for 124/130 anesthesiologists (95.4%). LOR to normal saline was the medium of choice for all age groups, although LOR to air and LOR to air/saline gained in popularity with increasing patient age. The majority of anesthesiologists do not change their LOR technique for different patient ages or level of epidural insertion. Most responders ranked ‘training’ as the most important determinant of practice, whereas ‘departmental guidelines’ were considered the least important. No complication attributable to the LOR technique used was reported.

Conclusion: LOR to normal saline is the preferred method for identification of the epidural space in children of all age groups. The suggestion by experts that LOR to air should be used in neonates and infants was not supported by the practice of pediatric anesthesiologists across Canada.

This article has been cited by other articles:

				M. Yamashita Objective techniques for identification of the epidural space in infants and children. Can J Anesth, April 1, 2006; 53(4): 420 - 421. [Full Text] [PDF]