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LETTERS TO THE EDITOR

Thoracic Epidural Catheter Placement in Infants via the Caudal Approach Under Electrocardiographic Guidance: Simplification of the Original Technique

Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada

To the Editor:

In a previous study published in this journal (1), we proposed the use of electrocardiography (ECG) to guide the tip of an epidural catheter from caudal space to thoracic region. In this prospective study, simultaneous ECG tracings were recorded via the epidural catheter and the target spinal surface ECG using a modified 2-channel 5-lead ECG system with lead II, III mode. This technique required replacing a commonly used standard 3-lead cable with a 5-lead ECG cable, which is not always readily available in pediatric anesthesia. To solve this problem, we have simplified our ECG technique to allow the use of a standard 3-lead ECG (Fig. 1). First, a standard ECG (lead II) is recorded by connecting the right-arm electrode (white) to a skin electrode on the patient’s back at the target spinal level, while the left-arm electrode (black) and left-leg electrode (red) are placed at their standard position. The shape of this initial ECG must be remembered or a hard copy must be taken as a reference for later. Next, the right-arm electrode is connected to the metal hub of the ECG adapter to record a tracing from the epidural catheter. A satisfactory tracing (lead II) is obtained when the epidural catheter is filled with saline allowing the catheter tip to become a unipolar ECG electrode. The catheter is then advanced from the caudal space until the tip reaches the target level as demonstrated by a match between its ECG configuration and the initial surface ECG.

View larger version (75K): [in this window] [in a new window]   Figure 1. Simplification of the epidural ECG technique.

1. Tsui BCH, Seal R, Koller J. Thoracic epidural catheter placement via the caudal approach in infants by using electrocardiographic guidance. Anesth Analg 2002; 95: 326–30.[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 ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Tsui, B. C. H. Search for Related Content PubMed PubMed Citation Articles by Tsui, B. C. H.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999