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SONOANATOMY OF NEURAXIAL STRUCTURES AND EPIDURAL CATHETER PLACEMENT IN NEONATES. RESULTS OF AN INTERNATIONAL SURVEY
ESRA Academy. Galante D. Sep 9, 2016; 138333; 0168 Topic: Paediatric Population
Dr. Dario Galante
Dr. Dario Galante

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Abstract
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Background and Aims:

We report the results of an international survey about  the experience of anesthesiologist to visualize the sonoanatomic neuraxial structures and correct epidural catheter insertion in neonates(1).

Methods:

250 questionnaire were sent to European and USA pediatric anesthesiologists via email, 187 returned  correctly completed (74.8%). The survey contained questions about gestational age and weight of neonates,  the ultrasound  identification of ligamentum flavum, the dura mater, the termination of the spinal cord and conus medullaris and their depth/width, the epidural catheter and its correct positioning. 

Results:

The examined neonates had a weight in a range between 1000 and 3850 gr and gestional age between 30 and 40 weeks. The ligamentum flavum, the dura mater, and the termination of the spinal cord were best identified in 98.6% of neonates  through acoustic window  in longitudinal paramedian and cross-sectional planes. Depth range at L2-L3 was 2.8-8.5 mm, at L3-L4 was 2.7-8.5 mm, termination of cord range was at L1-L3, width lumbar range was 1.3-3.2 mm. Ultrasound guided epidural catheter placement was performed successfully and correctly visualized  in 93.4% of patients. The epidural catheter tip was indentified in 91.3% of neonates.

Conclusions:

The survey demonstrated that ultrasound examination of the neuraxial structures in neonates enabled an excellent visualization and allowed the correct positioning of epidural catheter tip. Moreover, the research confirms the correlation between body weight and depth of epidural space published in literature.

References
1. Marhofer P et al. Pilot study of neuraxial imaging by ultrasound in infants and children. Paediatr Anaesth 2005;15:671-676.


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