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LETTER TO THE EDITOR

Errant Thoracic Epidural Catheterization

Department of Anesthesiology and Reanimation, Atatürk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey, hilalgun{at}yahoo.com

To the Editor:

We recently experienced an errant thoracic epidural catheter similar to that reported by Inoue et al. (1). A 20-yr-old man (weight, 67 kg; height, 181 cm) underwent left-sided thoracotomy for a pulmonary hydatic cyst. Before inducing general anesthesia, we inserted a thoracic epidural catheter for postthoracotomy pain management. We used the hanging-drop technique combined with median approach with the patient in the lateral decubitus position, and placed the epidural catheter at the T8-9 intervertebral space. After detecting negative pressure with the hanging drop, we advanced the epidural catheter 5 cm beyond the introducer needle tip, without technical difficulties. A test dose of 1% lidocaine 3 mL excluded unintentional subarachnoid injection. After induction, we placed a left-sided, double-lumen tube, permitting deflation of the left lung. Approximately 1 h after surgery began, the surgeon located the epidural catheter in the left pleural cavity (Fig. 1). We immediately withdrew the catheter. The anesthetic proceeded unremarkably.

View larger version (103K): [in this window] [in a new window]   Figure 1. Epidural catheter in left pleural cavity.

The hanging-drop technique cannot distinguish the pleural cavity from the epidural space. Therefore, we believe one should demonstrate neural blockade to verify that the catheter is in the epidural space before the induction of general anesthesia.

REFERENCE

1. Inoue S, Nishimine N, Furuya H. Unintentional intrapleural insertion of an epidural catheter: should we remove it or leave it in situ to provide perioperative analgesia? Anesth Analg 2005;100:266–8.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Alagöz, A. Articles by Savkiliodlu, E. Search for Related Content PubMed PubMed Citation Articles by Alagöz, A. Articles by Savkiliodlu, E.