Knotted epidural catheter in an infant: A case report

Ravishankar, Chandrakala Kunigal

doi:10.4103/ija.ija_458_16

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…Additionally, it may be that subcutaneous looping or dislodgement of the catheter without visible migration outside the skin might be present in patients who have had adverse events in the group without catheter migration. [ 23 ]…”

Section: Discussionmentioning

confidence: 99%

Epidural catheter migration in non-obstetric adult surgical patients: A prospective, observational, cohort study

Jose,

Greenlin,

Isac

et al. 2023

Indian Journal of Anaesthesia

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Background and Aims: Epidural catheter migration is a well-described complication in the obstetric population, though its significance in the non-obstetric surgical population is not known. The purpose of this study was to explore the incidence of epidural catheter migration in a non-obstetric adult surgical cohort, assess the factors associated with migration and analyse complications among patients with and without catheter migration. Methods: In this single-centre, prospective, observational study, the acute pain services team collected data over 12 months on consecutive, adult non-obstetric surgical patients who received an epidural catheter for postoperative pain management. Details of epidural catheter insertion, fixation, migration and complications were collected from the first to the fourth postoperative day. Results: Of the 510 patients recruited, epidural catheter migration was noted in 233 patients (45.7%), of which 152 (65.2%) migrated outwards and the rest migrated inwards. Also, 72 (30.9%) and 86 (31.05%) complications were noted in the groups with and without catheter migration, respectively. The most frequent complications noted were inadequate analgesia, unilateral sensory block, motor block and hypotension in both groups. We did not find any correlation between the frequency of epidural catheter migration and demographic factors. Conclusions: Epidural catheter migration is a sizeable postoperative occurrence in non-obstetric surgical patients. Factors that might play a role in catheter migration could not be established in this study. There is an almost similar frequency of complications noted among patients with and without catheter migration, with the most common being inadequate analgesia in both groups.

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Section: Discussionmentioning

confidence: 99%

Epidural catheter migration in non-obstetric adult surgical patients: A prospective, observational, cohort study

Jose,

Greenlin,

Isac

et al. 2023

Indian Journal of Anaesthesia

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“…Real-time visualisation of the epidural catheter and location of the catheter tip can be detected in newborns and infants. 15 Complications related to catheter placement in central neuroaxis, [16][17][18] have also decreased, and accuracy has improved with US guidance. Increasing application of PRA does create unique issues, such as parental demand and teenager refusal of epidural anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Complications in paediatric regional anaesthesia: a narrative review

Ponde¹,

Uemera²,

Singh³

2020

South Afr J Anaesth Analg

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Paediatric anaesthesia and paediatric regional anaesthesia are intertwined. Currently, almost all paediatric patients posted for surgery could and should be given a regional block unless and until contraindicated. This is because the scope, techniques, and their benefits have a wide range and complications are rare. The first report that used regional anaesthesia in children was in 1898, and over the last 120 years it has been developed with many scholars’ wisdom, ideas and publications. Paediatric regional anaesthesia (PRA) has many advantages but requires experience and expertise. For a long-time, exclusively landmark-guided techniques were used and gradually the development of new techniques such as the use of neuro-stimulator and ultrasound-guided (USG) blocks developed into PRA. Especially, the application of ultrasonography (US) has revolutionised the practice of PRA. Few limitations of regional anaesthesia can be tackled by the use of US, leading to shorter time to perform the block, reduced time for block onset and use of a smaller volume of local anaesthetic. Life threatening complications of regional anaesthesia are rare and the riskbenefit ratio is favourable. However, a thorough insight into RA complications, no matter how rare they are, is essential for safe practice. This is because they can be life-threatening, and no matter how small the percentage is, when complications occur, for that individual patient statistics is irrelevant.

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A Pediatric Epidural Catheter Fracture Suspected to Be Caused by a Glue

Yagihara,

Uemura,

Wakuda

et al. 2024

Cureus

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A 65-day-old baby boy underwent the Kasai procedure under general and epidural anesthesia. The epidural catheter was inserted between the T11 and T12 vertebrae under general anesthesia, and secured with sterile tape, ethyl-2-cyanoacrylate glue, and film. Intra- and postoperative epidural analgesia was effective and there was no leakage around the insertion site. On the third day post-surgery, we tried to remove the catheter but discovered it was fractured 67mm from the tip. During the ultrasound examination, we observed a hyper-echoic structure located between the laminae of T11/T12. The pediatric orthopedic surgeon recommended removing the catheter to avoid long-term neurological sequelae of leaving the catheter, such as infection, fibrosis, migration, and irritation of neural tissues. It was surgically removed uneventfully on postoperative day 4. We requested the manufacturer to inspect the cross-section of the catheter under a microscope. The cross-section showed that 20% of the area had undergone tearing due to traction, while the remaining 80% was cracked. We also requested the manufacturer simulation after that. The same catheter, fixed on the polyolefin resin plate instead of skin with the same tape and glue, was easily fractured after three days. It is suspected that using ethyl-2-cyanoacrylate glue caused the catheter to fracture. When using glue containing ethyl-2-cyanoacrylate for pediatric epidural catheter fixation, special care is advised.

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Knotted epidural catheter in an infant: A case report

Cited by 3 publications

References 6 publications

Epidural catheter migration in non-obstetric adult surgical patients: A prospective, observational, cohort study

Epidural catheter migration in non-obstetric adult surgical patients: A prospective, observational, cohort study

Complications in paediatric regional anaesthesia: a narrative review

A Pediatric Epidural Catheter Fracture Suspected to Be Caused by a Glue

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