Blanco D, Llamazares J, Martínez-Mora J, Vidal F
Servico de Anestesiología Reanimación y Terapia del Dolor, Hospital Universitario de Badalona Germans Trias i Pujol, Barcelona.
Rev Esp Anestesiol Reanim. 1994 Jul-Aug;41(4):214-6.
To evaluate the success and degree of difficulty of inserting an epidural catheter into the caudal space in order to place its distal end at T10 in young patients.
Forty-seven children up to 97 months old were studied. With the patients under general anesthesia with an orotracheal tube, a predetermined length of 18-G epidural catheter (Minipack: SYSTEM 2-Portex) was inserted to T10. X-rays were taken after surgery with 0.3 ml of iodine contrast. The catheter was considered well-placed if the distal end was between T10-T12; the approach was classified as easy, difficult or impossible.
The catheter was placed at T12-T10 on 16 occasions: 6 in L1, 3 in L2, 4 in L3, 17 in L4-L5, and 1 in S1. T10-T12 was reached in 52% of patients under 1 year of age, but in only 17% of children older than 1 year. The L4-L5 epidural space was reached with 46 of 47 catheters. Advance was easy in 41 cases, with only 16 reaching the objective. Advance was difficult in 6 cases, with only 1 reaching L1 and none reaching T10-T12. All catheters were easily removed.
It is not possible to guarantee the arrival of an 18-G epidural catheter to the thoracic epidural space by entering through the caudal route. In children over 1 year of age, the level of success decreases significantly. Easy advance of the catheter cannot be taken to be a sign of success.
评估在年轻患者中将硬膜外导管插入骶管间隙并将其远端置于T10水平的成功率和难度。
对47名年龄在97个月以下的儿童进行研究。在患者经口气管插管全身麻醉下，将预定长度的18G硬膜外导管（Minipack：SYSTEM 2-Portex）插入至T10水平。术后注入0.3 ml碘造影剂后进行X线检查。如果导管远端位于T10 - T12之间，则认为导管放置良好；将穿刺途径分为容易、困难或不可能。
导管放置于T12 - T10水平共16次：L1水平6次，L2水平3次，L3水平4次，L4 - L5水平17次，S1水平1次。1岁以下患者中52%达到T10 - T12水平，但1岁以上儿童仅17%达到该水平。47根导管中有46根进入了L4 - L5硬膜外间隙。41例推进过程容易，其中仅16例达到目标位置。6例推进困难，仅1例到达L1水平，无1例到达T10 - T12水平。所有导管均易于拔除。
通过骶管途径无法保证18G硬膜外导管进入胸段硬膜外间隙。1岁以上儿童的成功率显著降低。导管推进容易不能作为成功的标志。
