Department of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Kohtoh-ku, Tokyo, 136-0075, Japan.
Department of Reconstructive Surgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Tokyo, Nakano-ku, 164-8521, Japan.
J Anesth. 2022 Jun;36(3):335-340. doi: 10.1007/s00540-022-03048-5. Epub 2022 Mar 4.
To investigate the paths of thoracic epidural catheters in children, this retrospective study was performed.
We investigated 73 children aged 4 to 12 (mean ± SD 7.8 ± 2.3) years, who underwent the Nuss procedure for pectus excavatum repair under combined general and epidural anesthesia over a 5-year period at Tokyo Metropolitan Police Hospital. Following induction of general anesthesia, we inserted a radiopaque epidural catheter via the T5/6 or T6/7 interspace and advanced for 5 cm cephalad in the thoracic epidural space. We evaluated the paths of the epidural catheters on plain chest radiographs after surgery.
The median level for the catheter tip location was T3 (range C6-T7), while the median number of vertebrae crossed by the catheter tips was 2.5. In most children, the catheters advanced straight for the first 2-3 cm (1-1.5 vertebrae) in the thoracic epidural space. However, they continued to advance straight in only 25 children, while they exhibited curved or coiled paths in the remaining 48. The catheter tips were located at higher levels in children with straight epidural catheter paths [median (range) T2 (C6-T4)] than in those with curved or coiled paths after the initial 2-3 cm [median (range) T4 (T2-T7)] (p < 0.0001).
Our findings indicate that the course of epidural catheters in children is unpredictable after the first 2-3 cm in the thoracic epidural space. Clinicians should be aware of such findings, although further studies are required for confirmation.
为了研究儿童胸椎硬膜外导管的路径，我们进行了这项回顾性研究。
我们调查了 73 名年龄在 4 至 12 岁（平均年龄 7.8 ± 2.3 岁）的儿童，他们在过去 5 年内在东京都警察医院接受了联合全身麻醉和硬膜外麻醉下的 Nuss 手术治疗漏斗胸。全身麻醉诱导后，我们通过 T5/6 或 T6/7 椎间隙插入一个不透射线的硬膜外导管，并在胸椎硬膜外腔内向头侧推进 5cm。我们在手术后的胸部平片上评估硬膜外导管的路径。
导管尖端位置的中位数为 T3（范围 C6-T7），而导管尖端穿过的中位数为 2.5 个椎体。在大多数儿童中，导管在胸椎硬膜外腔中最初 2-3cm（1-1.5 个椎体）内呈直线前进。然而，只有 25 名儿童的导管继续直线前进，而在其余 48 名儿童中，导管呈弯曲或卷曲的路径。在最初 2-3cm 后，具有直线硬膜外导管路径的儿童（中位数（范围）T2（C6-T4））的导管尖端位置高于具有弯曲或卷曲路径的儿童（中位数（范围）T4（T2-T7））（p<0.0001）。
我们的发现表明，儿童硬膜外导管在胸椎硬膜外腔最初 2-3cm 后，其路径是不可预测的。临床医生应该意识到这一发现，尽管需要进一步的研究来证实。
