[Downloaded free from http://www.aeronline.org on Thursday, December 28, 2017, IP: 37.77.69.51]
Anesthesia: Essays and Researches; 9(3); Sep-Dec 2015
Letters to Editor Department of Anaesthesiology and Critical Care, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India Corresponding author: Dr. Monu Yadav, Department of Anaesthesiology and Critical Care, Nizam’s Institute of Medical Sciences Hyderabad, Telangana, India. E‑mail:
[email protected]
REFERENCES 1.
Figure 1: Laryngeal mask airway with spiral fracture of shaft
potential risk of airway obstruction, hypoxia, and aspiration of fragments of the tube. Therefore, in the view of patient’s safety for re‑usable LMA, pre‑use checks should always be carried out before each of the warranted uses. After each use cleansing followed by decontamination and sterilization with a validated method for its effectiveness of cleaning without damage to the LMA should be done.
Financial support and sponsorship
2. 3.
Yamaguchi S, Mishio M, Okuda Y, Kitajima T. Damage of a laryngeal mask airway during anesthesia. Masui 2000;49:762‑4. Heffernan AM, White M, Curran A, Colbert SA. Laryngeal mask airway severed by biting. Eur J Anaesthesiol 2003;20:74‑5. Wong DT, McGuire GP. Fractured laryngeal mask airway (LMA). Can J Anaesth 2000;47:716.
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. Access this article online Quick Response Code Website: www.aeronline.org
Nil.
Conflicts of interest
There are no conflicts of interest.
Monu Yadav, G. Sandeep, R. Mahesh, R. Gopinath
DOI: 10.4103/0259-1162.161808
How to cite this article: Yadav M, Sandeep G, Mahesh R, Gopinath R. Fractured laryngeal mask airway: Hazards of excessive reuse. Anesth Essays Res 2015;9:453-4.
Knotted epidural catheter during subcutaneous tunneling: An option Sir, Outward or inward migration of epidural catheters is a common problem encounters during epidural catheter insertion. Different catheter fixation techniques are been described in the medical literature. The technique of making subcutaneous tunnel for securing epidural catheter is safe and free of cost technique.[1‑3] We share an interesting case of knot in epidural catheter while making subcutaneous skin tunnel for epidural catheter fixation. A 22‑year‑old boy was posted for total open nephrectomy for angiomyolipoma of the left kidney. For intraoperative and postoperative analgesia epidural catheter was inserted at T12‑L1 inters pace. An 18 gauge epidural needle was used and procedure was performed using loss of resistance technique. Epidural catheter was fixed by tunneling the 454
catheter at subcutaneous tissue depth. However, just before fixing the catheter with clear transparent adhesive tape a knot appeared on the epidural catheter [Figure 1a]. Now, we had two options one is either to open the epidural drug port and release the catheter and again pass the epidural catheter from subcutaneous tunnel to release the knot. This is followed by again passing the catheter from subcutaneous tunnel. However, such a manoeuvre will breach aseptic practice. Another option we had was to leave the catheter in its natural curve form and fix it in that manner. As the epidural test dose of 3 mL (2% xylocaine with adrenaline 1:200,000) went smooth with no obstruction, so we had planned to fix the epidural catheter in its own natural curve [Figure 1b], and again checked the epidural catheter for any resistance to
[Downloaded free from http://www.aeronline.org on Thursday, December 28, 2017, IP: 37.77.69.51]
Anesthesia: Essays and Researches; 9(3); Sep-Dec 2015
Letters to Editor
Amit Rastogi, Sandeep Sahu, Rudrashish Haldar, Prabhat Kumar Singh Deaprtment of Anaesthesiology, Sanjay Gandhi Postgraduate of Medical Sciences, Lucknow, Uttar Pradesh, India a
Corresponding author: Dr. Amit Rastogi, Department of Anaesthesiology, Sanjay Gandhi Postgraduate of Medical Sciences, Lucknow, Uttar Pradesh, India. E‑mail:
[email protected]
b
Financial support and sponsorship Nil. c Figure 1: How to fix the epidural catheter and check for its proper functioning
drug injection [Figure 1c]. In absence of any resistance for drug injection, we went ahead with our epidural analgesia. Epidural analgesia was given by 0.0625% bupivacine with 2 µg/mL of fentanyl with elastomeric pump, and patient pain was controlled predictably. The epidural catheter was removed on 4th day uneventfully. Reported incidence of epidural abscess is around 0.01–0.1%.[4] In any circumstances if we breech the aseptic standards there are high chances of contamination of epidural catheter tip. Coming from an unsterile side to sterile side and opening of catheter port just to unknot the catheter might result in contamination. Precaution should be taken while fixing the epidural catheter using subcutaneous tunnel technique, but inadvertent incidences like knot in epidural catheter can happen even in most experienced hands.[5] As in this case test dose given was free flow so we decided to fix the catheter in its own natural curve form and acute pain services where informed. Information to acute pain services and mentioning of such an event in patient medical record is important as it will help in troubleshooting any time if epidural analgesia fails in postoperative period. We want to highlight the fact that this technique can be useful if same incidence of epidural catheter knot occurs during subcutaneous tunneling in clinical practice.
Conflicts of interest
There are no conflicts of interest.
REFERENCES 1.
Tripathi M. Safe practices in epidural catheter tunneling. J Anaesthesiol Clin Pharmacol 2012;28:138‑9. 2. Tripathi M, Pandey M. Epidural catheter fixation: Subcutaneous tunnelling with a loop to prevent displacement. Anaesthesia 2000;55:1113‑6. 3. Rose GL. Subcutaneous catheter tunneling. Reg Anesth Pain Med 2009;34:379. 4. Gosavi C, Bland D, Poddar R, Horst C. Epidural abscess complicating insertion of epidural catheters. Br J Anaesth 2004;92:294‑5. 5. Joselyn A, Bhalla T, Schloss B, Martin D, Tobias J. A case report of a retained and knotted caudal catheter. Saudi J Anaesth 2014;8:424‑7.
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. Access this article online Quick Response Code Website: www.aeronline.org
DOI: 10.4103/0259-1162.158513
How to cite this article: Rastogi A, Sahu S, Haldar R, Singh PK. Knotted epidural catheter during subcutaneous tunneling: An option. Anesth Essays Res 2015;9:454-5.
455
