This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yamashita, M. Search for Related Content PubMed PubMed Citation Articles by Yamashita, M.

Objective techniques for identification of the epidural space in infants and children

Ibaraki Children’s Hospital, Mito, Japan, E-mail: myamashita{at}med.email.ne.jp

To the Editor:

I read with interest the results of a survey of Canadian pediatric anesthesiologists regarding identification of the epidural space in infants and children.¹ However, I was somewhat disappointed to learn that the iv micro-drip infusion set technique for identification of the space² is not being practiced in Canada. This technique enables the operator to hold the epidural needle with two hands, thus providing more precise control of the needle, and identify the epidural space by an objective sign, either free flow of fluid from the drip chamber, or by movement of a tiny air bubble at the hub of the needle towards the epidural space.^3,4 We have used this technique in more than 2,000 infants and children at our institution.⁴ In 1,385 infants and children, lumbar epidural puncture was successful on the first attempt (90.2%) and on the second attempt in an additional 8.0%.

The survey¹ also failed to include another method to identify the epidural space as reported by Suwa et al.⁵ In place of a drip infusion set, these authors connected the epidural needle via an iv extension tube to a pressure-transducer. They identified the epidural space in 25/25 (100%) children without dural puncture by observing a sudden decrease in pressure when the epidural space was accessed. As a control, they used the loss-of-resistance to saline, and their success rate was 84% (21/25), with a dural puncture incidence of 4% (1/25). This pressure-guided method is also objective, but may be too expensive for some clinical settings.

I hope that by drawing the readers’ attention to these methods of identifying the epidural space, more clinicians will consider replacing the loss-of-resistance techniques to saline and air, with these alternative objective techniques.

Footnotes

Accepted for publication November 30, 2005.

References

1 Ames WA, Hayes JA, Petroz GC, Roy WL. Loss of resistance to normal saline is preferred to identify the epidural space: a survey of Canadian pediatric anesthesiologists. Can J Anesth 2005; 52: 607–12.[Abstract/Free Full Text]

2 Yamashita M, Tsuji M. Identification of the epidural space with an i.v. micro-drip infusion set in infants and children. Can J Anaesth 1990; 37(4 Pt 2): S99.

3 Yamashita M, Tsuji M. Identification of the epidural space in children. The application of a micro-drip infusion set. Anaesthesia 1991; 46: 872–4.[Medline]

4 Osaka Y, Yamashita M. Intervertebral epidural anesthesia in 2,050 infants and children using the drip and tube method. Reg Anesth Pain Med 2003; 28: 103–7.[Medline]

5 Suwa T, Inomata S Saito S, Toyooka H. Pressure-guided method for identification of the epidural space in children. Anesthesiology 1998; 89: 546–8.[Medline]

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yamashita, M. Search for Related Content PubMed PubMed Citation Articles by Yamashita, M.