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Thoracic epidural analgesia via the lumbar approach using nerve stimulation in a pediatric patient with Down syndrome.

Abstract：

:This case illustrates the threading of an epidural catheter with electrical stimulation guidance from the lumbar epidural space to the thoracic space in a pediatric patient. A 17-year-old boy with Down syndrome, weighing 48 kg, was scheduled to undergo a laparotomy for duodenal obstruction and gastrostomy tube insertion. Combined general and continuous epidural anesthesia was selected for his anesthetic. Following the induction of general anesthesia and tracheal intubation, a 17G Tuohy needle (Arrow International, Inc., Reading, PA) was inserted into the lumbar space (L3-4) using loss of resistance with air. A 20G styletted epidural catheter was then inserted and threaded cranially. As the catheter was advanced, a low electrical current (1-10mA) was applied to the catheter. Motor response was observed from the lower limb muscles to the upper abdominal muscles as the catheter advanced cranially. After 22 cm of the epidural catheter had been inserted, intercostal muscle movement (T9 - 10) was observed at 3.0 mA. Radiographical imaging later confirmed the catheter tip at T10. The patient awoke without distress and was discharged to the ward with subsequent good pain control from a continuous epidural infusion of bupivacaine 0.1% with 1 microg ml(-1) fentanyl at 4-6 ml(-1).

journal_name

Acta Anaesthesiol Scand

journal_title

Acta anaesthesiologica Scandinavica

authors

Tsui BC,Entwistle L

doi

10.1111/j.1399-6576.2005.00684.x

subject

Has Abstract

pub_date

2005-05-01 00:00:00

pages

712-4

issue

5

eissn

0001-5172

issn

1399-6576

pii

AAS684

journal_volume

49

pub_type

杂志文章

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