Tsui Ban C H, Kulkarni Pradeep
Department of Anesthesiology and Pain Medicine, Edmonton, Alberta, Canada.
Anesth Analg. 2009 Jan;108(1):371-3. doi: 10.1213/ane.0b013e31818e0ee2.
We describe a documented migration of a thoracic epidural catheter into the thoracic cage in a 5-wk-old with DiGeorge's syndrome and an uncorrected acyanotic Tetralogy of Fallot who underwent laparotomy for malrotation, gastric fundoplication, and gastrostomy tube insertion under combined general and epidural anesthesia. A 20-gauge stimulating catheter was inserted caudally and advanced cephalad to the thoracic level while applying a low electrical current (1-10 mA) to confirm epidural placement at approximately T5-6. Despite good pain control through the third postoperative day, using an epidural infusion of bupivacaine 0.1% at 1-1.2 mL/h, radiography demonstrated catheter migration into the seventh intercostal space.
我们描述了一名5周大患有DiGeorge综合征且法洛四联症未矫正、无青紫的患儿，在全身麻醉联合硬膜外麻醉下行剖腹探查术以治疗肠旋转不良、胃底折叠术和胃造瘘管置入术时，一根胸段硬膜外导管记录在案地移入胸廓内的情况。一根20号刺激导管经尾端插入，在施加低电流（1 - 10 mA）的同时向头端推进至胸段水平，以确认在大约T5 - 6处的硬膜外置管位置。尽管术后第三天通过以1 - 1.2 mL/h的速度硬膜外输注0.1%布比卡因实现了良好的疼痛控制，但影像学检查显示导管已移入第七肋间间隙。
