ABSTRACT
Caudal catheters advanced to the lumbar and thoracic regions can be used to provide excellent analgesia for pre-term neonates undergoing major abdominal and thoracic procedures. Despite their frequent use, attention to detail is mandatory to avoid complications related to the medications used or the placement technique. We present a 2-day-old, 2 kg, pre-term infant who was born at 32 weeks gestational age with a tracheoesophageal fistula. Following anesthetic induction, a caudal epidural catheter was placed with the intent of threading it to the mid-thoracic level. The intraoperative and post-operative courses were uneventful with the epidural catheter providing adequate analgesia without the need for supplemental intravenous opioids. During catheter removal, resistance was noted and it could not be easily removed. With repositioning and various other maneuvers, the catheter was removed with some difficulty. On examination of the catheter, a complete knot was noted. Options for catheter advancement from the caudal space to the thoracic dermatomes are reviewed and techniques discussed for removal of a retained epidural catheter
ABSTRACT
Most primary and secondary level hospitals in developing countries provide inadequate labor analgesia due to various medical, technical and economic reasons. This clinical trial was an effort to study the efficacy, safety and feasibility of intravenous [IV] ketamine to provide labor analgesia. A total of 70 parturients were consented and randomly assigned to receive either IV ketamine or 0.9% saline. A loading dose of ketamine [0.2 mg/kg] was followed-by an infusion [0.2 mg/kg/h] until the delivery of the neonate. Similar volume of saline was infused in the placebo-group. Intramuscular meperidine was the rescue analgesic in both groups. The pain score, hemodynamic parameters of mother and fetus and the anticipated side-effects of ketamine were observed for. The newborn was assessed by the Neonatologist. The pain score showed a decreasing trend in the ketamine group and after the 1[st] h more than 60% of women in the ketamine group had pain relief, which was statistically significant. There was no significant clinical change in the maternal hemodynamics and fetal heart rate. However, 17 [48.5%] of them had transient light headedness in the ketamine group. All the neonates were breast fed and the umbilical cord blood pH was between 7.1 and 7.2. The overall satisfaction was significantly high in the intervention group [P = 0.028]. A low-dose ketamine infusion [loading dose of 0.2 mg/kg delivered over 30 min, followed-by an infusion at 0.2 mg/kg/h] could provide acceptable analgesia during labor and delivery