Caudally threaded thoracic epidural catheter as the sole anesthetic in a premature infant and ultrasound confirmation of the catheter tip.

摘要

A 2-week-old infant weighing 2.3 kg, with trisomy 18, was scheduled for placement of a gastrostomy tube. She had multiple severe anomalies including complex congenital heart disease and absence of corpus callosum. She was also positive for sickle cell disease. The family, in concert with the neonatal intensivists, agreed to withhold aggressive therapies in favor of palliative and comfort measures. The goal was to bring the baby on a stable feeding regimen; the baby was to be discharged in anticipation of a short life expectancy. The neonatologists inquired about the feasibility of doing an anesthetic technique that avoided general anesthetics and endotracheal intubation. It was decided to proceed with a caudally placed epidural catheter threaded to the thoracic level, while keeping the infant awake.