title: A case report of a retained and knotted caudal catheter.
abstract: Caudal catheters advanced to the lumbar and thoracic regions can be used to provide excellent analgesia for pre-term neonates undergoing major abdominal and thoracic procedures. Despite their frequent use, attention to detail is mandatory to avoid complications related to the medications used or the placement technique. We present a 2-day-old, 2 kg, pre-term infant who was born at 32 weeks gestational age with a tracheoesophageal fistula. Following anesthetic induction, a caudal epidural catheter was placed with the intent of threading it to the mid-thoracic level. The intraoperative and post-operative courses were uneventful with the epidural catheter providing adequate analgesia without the need for supplemental intravenous opioids. During catheter removal, resistance was noted and it could not be easily removed. With repositioning and various other maneuvers, the catheter was removed with some difficulty. On examination of the catheter, a complete knot was noted. Options for catheter advancement from the caudal space to the thoracic dermatomes are reviewed and techniques discussed for removal of a retained epidural catheter.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Joselyn
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio, USA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Bhalla
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Schloss
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio, USA.
authors.forename: David
authors.initials: D
authors.lastname: Martin
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Tobias
keywords: Knotted caudal catheter; pre-term neonate; retained caudal catheter