title: Thoracic epidural catheter insertion using the caudal approach assisted with an electrical nerve stimulator in young children.
abstract: OBJECTIVE
  We evaluated whether thoracic epidural catheter placement using the caudal approach and assisted with an electrical stimulator could be performed in young children.
  
  
  METHODS
  Ten young children (1-4 years) who underwent abdominal surgeries were studied. Under general anesthesia without muscle relaxants, caudal catheter placement was performed using an 18-gauge Crawford-type needle and a 20-gauge radiopaque epidural catheter with a stainless-steel stylet. A metal adapter and a 3-way stopcock were attached to the catheter to connect to an electrical stimulator and to inject physiological saline. Electrical stimulation was performed intermittently while advancing the catheter until it reached the target length. The catheter position was confirmed on postoperative roentgenogram.
  
  
  RESULTS
  The mean age of the subjects was 32.2 +/- 10.1 months (13-48 months), and the height was 85.3 +/- 6.1 cm (72-93 cm). In 9 of 10 patients, an epidural catheter could be placed at the first insertion. In 1 patient, the catheter could be placed successfully at the second insertion. The electrical current required for muscle contraction at the target length was 5.8 +/- 1.5 mA.
  
  
  CONCLUSIONS
  Electrical stimulation reliably indicated the location of the catheter tip. This technique for thoracic epidural catheter insertion was easy to perform and could be used in young children.
authors.affiliation: Department of Anesthesiology, The University of Tokyo, Tokyo, Japan. tamaih-dis@h.u-tokyo.ac.jp
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Tamai
authors.forename: Shigehito
authors.initials: S
authors.lastname: Sawamura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kanamori
authors.forename: Kenji
authors.initials: K
authors.lastname: Takeda
authors.forename: Mieko
authors.initials: M
authors.lastname: Chinzei
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hanaoka
mesh_terms: D015360:Analgesia, Epidural / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization / Q000295:instrumentation; D002675:Child, Preschool; D004558:Electric Stimulation / Q000295:instrumentation*; D004867:Equipment Design; D004869:Equipment Safety; D006801:Humans; D007223:Infant; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D009339:Needles; D013193:Stainless Steel; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
chemical_list: D013193:Stainless Steel