Multiport Epidural Catheters

Anesthesiology - Tập 92 Số 6 - Trang 1617-1620 - 2000
Barbara L. Leighton1, William G. Topkis2, Jeffrey B. Gross3, Valerie A. Arkoosh4, Sung-Hee R. Lee5, H. Jane Huffnagle6, Suzanne Huffnagle6
1Clinical Professor, Department of Anesthesiology, Weill Medical College of Cornell University, New York, New York.
2Attending Anesthesiologist, United Hospital, Port Chester, New York.
3Professor, Department of Anesthesiology, University of Connecticut, Hartford, Connecticut.
4Associate Professor, Departments of Anesthesiology and Obstetrics and Gynecology, MCP Hahnemann University, Phildelphia, Pennsylvania.
5Instructor in Anesthesiology, Weill Medical College of Cornell University, New York, New York.
6Assistant Professor, Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

Tóm tắt

Background Multiport epidural catheters are popular; however, the reliability of the air test has not been evaluated with this catheter design. The authors determined the effectiveness of aspirating for blood and the air test in detecting intravascular multiorifice epidural catheters. Methods Three hundred women in labor underwent placement of a blunt-tip, three-hole, 20-gauge, lumbar epidural catheter. If there were no signs of spinal anesthesia, 3 ml lidocaine or bupivacaine was injected and the patient was observed for signs of spinal anesthesia. If there were no signs of spinal anesthesia, the authors injected 1 ml air through the epidural catheter while listening to the maternal precordium using a Doppler fetal heart rate monitor. Catheters through which blood was aspirated were air-tested and replaced. Patients with air-test-positive, blood-aspiration-negative catheters received 100 mg lidocaine through the catheter and were questioned about toxicity symptoms. The authors injected bupivacaine-fentanyl through aspiration-negative,air-test-negative catheters and recorded the sensory analgesic level 20 min later. Results The authors aspirated cerebrospinal fluid through one catheter and documented intravascular placement in 11 catheters. Results of the air test and blood aspiration were positive for eight catheters. Blood could not be aspirated from one air-test-positive catheter; perioral numbness developed in the patient after lidocaine injection. Blood was freely aspirated from two air-test-negative catheters. In the remaining 288 catheters, bupivacaine-fentanyl injection produced epidural analgesia in 279 patients and no effect in 9 patients. Conclusions The authors obtained false-negative results with both catheter aspiration and the air test. Fractionating the local anesthetic dose is important when using multiorifice epidural catheters.

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Anesthesiology

Tập 92 Số 6

1617-1620

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