A survey of paediatric caudal extradural anaesthesia practice

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A survey of paediatric caudal extradural
anaesthesia practice

• R Menzies, K Congreve, V Herodes, S Berg
• and DG Mason
• Department of Paediatric Anaesthesia,
• Nuffield Department of Anaesthetics,
• Oxford

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Introduction

• Caudal anaesthesia is a very versatile and
  commonly performed technique, but little
  information available on practice employed
• Survey aimed to be a useful reference for
  individuals to compare their practice

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Methods

• Web based questionnaire of APAGBI members between
  April and June 2008
• Information gathered included
• Experience of anaesthetist, techniques employed,
  drugs used, use of caudal catheter techniques

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Results

• E mails were sent to 600 anaesthetists
• 388 visits logged to the survey website
• 22 visits were by responders who had multiple
  visits to the site without logging any responses
• Analysis was performed on the remaining 366
  entries

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Results
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Device used to access caudal space
Results
49 (10.5)
15 (3.2)
61 (16.2)
18G
Hollow needle
24G
82 (17.6)
20G
53 (14.1)
Styletted needle
262 (69.7)
22G
Cannula
319 (68.6)
Size of device used to access caudal space
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Risk of implantation of dermoid tissue

• 325 (91.5) did not believe there is a risk
• 30 (8.5) believed there is a risk
• 11 did not answer the question
• 314 (87.2) do not nick the skin prior to needle
  insertion

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Methods used to confirm correct placement
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Results
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Results

• Caudal catheter techniques
• used by 157 (43.6) of anaesthetists
• most used in children lt 2 years of age
• Asepsis
• For single shot
• 267 (74) use gloves only
• 55 (15.2) no touch technique
• 39 (10.8) use glove, gown and mask
• For caudal catheter
• 134 (91.8) use of glove, gown and mask

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Discussion

• Most anaesthetist use a cannula to access caudal
  space
• related to years of experience
• Few believe there is a risk of implantation
• Is there a role for ultrasound?
• Why isnt levobupivicaine more widely used?

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Discussion

• Additives are frequently used (off licence)
• opioids used less commonly
• What is best asepsis practice for single shot
  caudals?
• Caudal catheter technique remains popular for
  children lt 2 years of age

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Conclusions

• First large scale on-line survey of anaesthetists
  who perform caudal extradural anaesthesia in
  children
• Provides a snap shot of current practice
• Act as a useful reference for the development of
  enhanced techniques and new equipment to improve
  safety and efficacy in the future

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