Willschke Harald, Bosenberg Adrian, Marhofer Peter, Willschke Julie, Schwindt Jens, Weintraud Marion, Kapral Stephan, Kettner Stephan
Department of Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
Reg Anesth Pain Med. 2007 Jan-Feb;32(1):34-40. doi: 10.1016/j.rapm.2006.10.008.
We report the first prospective sonoanatomic study in neonates with the aim to perform ultrasonographic-guided epidural catheter placement in this age group.
One hundred forty-five neonates with a body weight < or =4 kg (0.53-4 kg) were included in this prospective study. The study was divided into 3 consecutive parts. In the first part, the neuraxial sonoanatomy of 60 neonates was evaluated. In the second part, 50 neonates scheduled for major abdominal surgery were enrolled. In this part, the depth of the ligamentum flavum measured with ultrasound was matched up to the depth evaluated clinically with the loss-of-resistance technique. In the third part, ultrasonographic epidural catheter placement was performed in 35 neonates weighing between 620 g and 4 kg.
The ligamentum flavum, the dura mater, and the termination of the spinal cord could be identified in all patients. The first part showed a good correlation between body weight and depth of the ligamentum flavum. The median termination of the spinal cord corresponded to vertebral level L2. The second part confirmed a good correlation between depth of the ligamentum flavum evaluated clinically and the depth predicted with ultrasound. Finally, real-time ultrasound-guided epidural placement was possible in all 35 neonates.
Ultrasound examination of the spinal cord anatomy provides valuable information for epidural catheter placement in neonates. Ultrasonography enables a real-time identification of the tip of the needle within the epidural space and a visualization of the spread of local anesthetic in these patients.
我们报告了首例针对新生儿的前瞻性超声解剖学研究，目的是在该年龄组中进行超声引导下的硬膜外导管置入。
145例体重≤4 kg（0.53-4 kg）的新生儿纳入了这项前瞻性研究。该研究分为连续的三个部分。第一部分，评估60例新生儿的脊柱超声解剖结构。第二部分，纳入50例计划进行大型腹部手术的新生儿。在这一部分中，用超声测量的黄韧带深度与通过阻力消失技术临床评估的深度进行匹配。第三部分，对35例体重在620 g至4 kg之间的新生儿进行超声引导下的硬膜外导管置入。
所有患者均能识别黄韧带、硬脑膜和脊髓末端。第一部分显示体重与黄韧带深度之间具有良好的相关性。脊髓的中位终止对应于L2椎体水平。第二部分证实了临床评估的黄韧带深度与超声预测的深度之间具有良好的相关性。最后，所有35例新生儿均成功进行了实时超声引导下的硬膜外导管置入。
脊髓解剖结构的超声检查为新生儿硬膜外导管置入提供了有价值的信息。超声检查能够实时识别硬膜外间隙内的针尖位置，并可视化这些患者局部麻醉药的扩散情况。
