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Ultrasound versus anatomical landmarks for caudal epidural anesthesia in pediatric patients.

Abukawa Y, Hiroki K, Morioka N, Iwakiri H, Fukada T, Higuchi H, Ozaki M - BMC Anesthesiol (2015)

Bottom Line: The base of the triangle increased in proportion to age up to 10 years old, with a significant correlation between age and the length of the base (Spearman's r value = 0.97).The triangle was not an equilateral triangle under 7 years old.We observed a correlation between age and the length of the triangle base in children under 10 years old.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Critical Care, Tokyo Women's Medical University, Tokyo, Japan. yukako1@rg8.so-net.ne.jp.

ABSTRACT

Background: Caudal block is easily performed because the landmarks are superficial. However, the sacral hiatus is small and shallow in pediatric patients. In the present study, we evaluated under general anesthesia whether the distance between the bilateral superolateral sacral crests increased with growth, whether an equilateral triangle was formed between the apex of the sacral hiatus and the bilateral superolateral sacral crests, and whether expansion of the epidural space could be confirmed by ultrasound.

Methods: This prospective observational study included 282 children who were ASA I-II. Under general anesthesia, each patient was placed in the lateral bent knees position, and the attending anesthesiologist drew an equilateral triangle and measured the distance between the bilateral superolateral sacral crests along a line forming the base of the triangle. Then the sacral hiatus was identified by ultrasound. Differences of the distance between the anatomical landmarks measured by the anesthetist and by ultrasound were evaluated.

Results: Two patients were excluded because the superolateral sacral crests and sacral hiatus could not be palpated. The base of the triangle increased in proportion to age up to 10 years old, with a significant correlation between age and the length of the base (Spearman's r value = 0.97). The triangle was not an equilateral triangle under 7 years old. The sacral hiatus could be identified by ultrasound and we could confirm expansion of the epidural space in all patients.

Conclusion: We observed a correlation between age and the length of the triangle base in children under 10 years old. Although detection of the anatomical landmarks by palpation differed from identification by ultrasound in pediatric patients, performing ultrasound is important. Epinephrine should be added to the anesthetic to avoid complications.

Trial registration: Current Controlled Trials UMIN000017898 . Registered 14 June 2015. Date of protocol fixation was 1(st) December, 2008 and Anticipated trial start date was 5(th) January, 2009.

No MeSH data available.


Related in: MedlinePlus

Correlation between age and the percent difference. The difference of the distance between the two superolateral sacral crests (anatomical landmarks) and identification by ultrasound was measured. The horizontal axis shows age and the vertical axis shows the percent difference between the anatomical landmarks and identification by ultrasound
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Fig2: Correlation between age and the percent difference. The difference of the distance between the two superolateral sacral crests (anatomical landmarks) and identification by ultrasound was measured. The horizontal axis shows age and the vertical axis shows the percent difference between the anatomical landmarks and identification by ultrasound

Mentions: It was difficult to detect the sacral hiatus by palpation in two patients (0.7 %) because of anatomical abnormality and obesity. However, ultrasound successfully identified the sacral hiatus in all patients. The heart rate increased after injection of the test dose in one patient (0.4 %) even though expansion of the epidural space was seen on ultrasound. Therefore, the needle was reinserted into the epidural space at another site and intravenous injection could be detected using epinephrine. There was no correlation between the percent difference and age (Fig. 2).Fig. 2


Ultrasound versus anatomical landmarks for caudal epidural anesthesia in pediatric patients.

Abukawa Y, Hiroki K, Morioka N, Iwakiri H, Fukada T, Higuchi H, Ozaki M - BMC Anesthesiol (2015)

Correlation between age and the percent difference. The difference of the distance between the two superolateral sacral crests (anatomical landmarks) and identification by ultrasound was measured. The horizontal axis shows age and the vertical axis shows the percent difference between the anatomical landmarks and identification by ultrasound
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4499894&req=5

Fig2: Correlation between age and the percent difference. The difference of the distance between the two superolateral sacral crests (anatomical landmarks) and identification by ultrasound was measured. The horizontal axis shows age and the vertical axis shows the percent difference between the anatomical landmarks and identification by ultrasound
Mentions: It was difficult to detect the sacral hiatus by palpation in two patients (0.7 %) because of anatomical abnormality and obesity. However, ultrasound successfully identified the sacral hiatus in all patients. The heart rate increased after injection of the test dose in one patient (0.4 %) even though expansion of the epidural space was seen on ultrasound. Therefore, the needle was reinserted into the epidural space at another site and intravenous injection could be detected using epinephrine. There was no correlation between the percent difference and age (Fig. 2).Fig. 2

Bottom Line: The base of the triangle increased in proportion to age up to 10 years old, with a significant correlation between age and the length of the base (Spearman's r value = 0.97).The triangle was not an equilateral triangle under 7 years old.We observed a correlation between age and the length of the triangle base in children under 10 years old.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Critical Care, Tokyo Women's Medical University, Tokyo, Japan. yukako1@rg8.so-net.ne.jp.

ABSTRACT

Background: Caudal block is easily performed because the landmarks are superficial. However, the sacral hiatus is small and shallow in pediatric patients. In the present study, we evaluated under general anesthesia whether the distance between the bilateral superolateral sacral crests increased with growth, whether an equilateral triangle was formed between the apex of the sacral hiatus and the bilateral superolateral sacral crests, and whether expansion of the epidural space could be confirmed by ultrasound.

Methods: This prospective observational study included 282 children who were ASA I-II. Under general anesthesia, each patient was placed in the lateral bent knees position, and the attending anesthesiologist drew an equilateral triangle and measured the distance between the bilateral superolateral sacral crests along a line forming the base of the triangle. Then the sacral hiatus was identified by ultrasound. Differences of the distance between the anatomical landmarks measured by the anesthetist and by ultrasound were evaluated.

Results: Two patients were excluded because the superolateral sacral crests and sacral hiatus could not be palpated. The base of the triangle increased in proportion to age up to 10 years old, with a significant correlation between age and the length of the base (Spearman's r value = 0.97). The triangle was not an equilateral triangle under 7 years old. The sacral hiatus could be identified by ultrasound and we could confirm expansion of the epidural space in all patients.

Conclusion: We observed a correlation between age and the length of the triangle base in children under 10 years old. Although detection of the anatomical landmarks by palpation differed from identification by ultrasound in pediatric patients, performing ultrasound is important. Epinephrine should be added to the anesthetic to avoid complications.

Trial registration: Current Controlled Trials UMIN000017898 . Registered 14 June 2015. Date of protocol fixation was 1(st) December, 2008 and Anticipated trial start date was 5(th) January, 2009.

No MeSH data available.


Related in: MedlinePlus