Loss of resistance to normal saline is preferred to identify the epidural space: a survey of Canadian pediatric anesthesiologists.
OBJECTIVE
Several methods have been described to locate the epidural space, but the loss-of-resistance (LOR) technique is the most commonly used. Expert opinion states that LOR to air is the best medium for neonates and infants. We conducted a Canada-wide postal survey to determine the current state of practice for placement of epidural catheters in pediatric patients.


METHODS
Two hundred and nine surveys were distributed to academic pediatric anesthesiologists across Canada. The survey was limited to six questions and was anonymous.


RESULTS
The response rate was 62.2%. LOR was the method of choice for 124/130 anesthesiologists (95.4%). LOR to normal saline was the medium of choice for all age groups, although LOR to air and LOR to air/saline gained in popularity with increasing patient age. The majority of anesthesiologists do not change their LOR technique for different patient ages or level of epidural insertion. Most responders ranked 'training' as the most important determinant of practice, whereas 'departmental guidelines' were considered the least important. No complication attributable to the LOR technique used was reported.


CONCLUSIONS
LOR to normal saline is the preferred method for identification of the epidural space in children of all age groups. The suggestion by experts that LOR to air should be used in neonates and infants was not supported by the practice of pediatric anesthesiologists across Canada.
Department of Anesthesia, Hospital for Sick Children, Toronto, Ontario, Canada. wads@doctors.org.uk
Warwick A
WA
Ames
Jason A
JA
Hayes
Guy C
GC
Pétroz
W Lawrence
WL
Roy
D000293:Adolescent; D000367:Age Factors; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D004824:Epidural Space / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012965:Sodium Chloride; D011795:Surveys and Questionnaires
D012965:Sodium Chloride