Abstract
To describe an alternative method of measuring the Epidural Waveform Analysis (EWA), a technique through which anesthesiologists can confirm the position of a needle and/or catheter tip in the epidural space. EWA consists of epidural catheter transduction with a pressure system typically used for invasive arterial blood pressure monitoring which generates a characteristic oscillatory waveform (provided the catheter tip is within the epidural space) in synchrony with the pulsatile epidural circulation. The technique requires a double-male connector, a 3-way stopcock and an arterial pressure extension tubing along with the patient’s existing arterial line setup while ensuring a meticulously sterile technique to mitigate the risks of neuraxial infection. The technique described herein has been successfully and routinely applied within our institution to measure EWA with the advantage of being potentially less wasteful. EWA allows anesthesiologists to confirm the correct position of an epidural needle/catheter. We describe a method of successfully measuring EWA while reducing wastefulness.
References
Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and management. Br J Anaesth. 2012;109:144–54. https://doi.org/10.1093/bja/aes214.
Chauvin C, Klar G, Hopman WM, da Silva LM, Day AG, Phelan R, McMullen M, Chen K, Moreira e Lima R, Mizubuti GB. Sensitivity and specificity of waveform analysis for assessing postoperative epidural function. J Clin Anesth. 2022;77:110630. https://doi.org/10.1016/j.jclinane.2021.110630.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Gregory Klar. The first draft of the manuscript was written by Gregory Klar and Glenio B. Mizubuti, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Klar, G., Ho, A.MH., McMullen, M. et al. A simple technique to assess postoperative epidural functionality. J Clin Monit Comput 36, 1903–1906 (2022). https://doi.org/10.1007/s10877-022-00867-5
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DOI: https://doi.org/10.1007/s10877-022-00867-5