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

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 gastr...

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Bibliographic Details
Published inActa anaesthesiologica Scandinavica Vol. 49; no. 5; pp. 712 - 714
Main Authors Tsui, B. C. H., Entwistle, L.
Format Journal Article
LanguageEnglish
Published Oxford, UK; Malden, USA Munksgaard International Publishers 01.05.2005
Subjects
Adolescent
Analgesia, Epidural - methods
Anesthesia, General
Digestive System Surgical Procedures
Down Syndrome - complications
Duodenal Obstruction - surgery
Electric Stimulation
Epidural Space - anatomy & histology
Gastrostomy
Humans
Intubation, Gastrointestinal
Laparotomy
Lumbar space
Male
nerve stimulation
thoracic epidural
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Summary: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 µg ml−1 fentanyl at 4–6 ml−1.
Bibliography:Supported in Part by an Education and Research Fund, Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Edmonton, Canada, and a Clinical Investigatorship Award, Alberta Heritage Foundation for Medical Research, Alberta, Canada. The principal author has a patent license agreement (US Patent #6190370) with Arrow International Inc. (Reading, PA) for the epidural kit described in the article.
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ISSN:0001-5172
1399-6576
DOI:10.1111/j.1399-6576.2005.00684.x