PDF(Pubmed)
Abstract：
A 65-day-old baby boy underwent the Kasai procedure under general and epidural anesthesia. The epidural catheter was inserted between the T11 and T12 vertebrae under general anesthesia, and secured with sterile tape, ethyl-2-cyanoacrylate glue, and film. Intra- and postoperative epidural analgesia was effective and there was no leakage around the insertion site. On the third day post-surgery, we tried to remove the catheter but discovered it was fractured 67mm from the tip. During the ultrasound examination, we observed a hyper-echoic structure located between the laminae of T11/T12. The pediatric orthopedic surgeon recommended removing the catheter to avoid long-term neurological sequelae of leaving the catheter, such as infection, fibrosis, migration, and irritation of neural tissues. It was surgically removed uneventfully on postoperative day 4. We requested the manufacturer to inspect the cross-section of the catheter under a microscope. The cross-section showed that 20% of the area had undergone tearing due to traction, while the remaining 80% was cracked. We also requested the manufacturer simulation after that. The same catheter, fixed on the polyolefin resin plate instead of skin with the same tape and glue, was easily fractured after three days. It is suspected that using ethyl-2-cyanoacrylate glue caused the catheter to fracture. When using glue containing ethyl-2-cyanoacrylate for pediatric epidural catheter fixation, special care is advised.
摘要：
一名65天大的男婴在全身麻醉和硬膜外麻醉下接受了Kasai手术。在全身麻醉下将硬膜外导管插入T11和T12椎骨之间，并用无菌胶带固定，2-氰基丙烯酸乙酯胶,和电影。硬膜外和术后硬膜外镇痛有效，插入部位周围无渗漏。手术后第三天,我们试图取出导管，但发现它在尖端67毫米处断裂。在超声检查期间，我们观察到位于T11/T12层之间的超回声结构。小儿整形外科医生建议移除导管，以避免留下导管的长期神经后遗症，如感染，纤维化，迁移,和刺激神经组织。它在术后第4天顺利手术切除。我们要求制造商在显微镜下检查导管的横截面。横截面显示，由于牵引力，20%的区域发生了撕裂，而其余80%被破解。之后，我们还要求制造商进行模拟。同样的导管,用相同的胶带和胶水固定在聚烯烃树脂板上而不是皮肤上，三天后很容易骨折.怀疑使用2-氰基丙烯酸乙酯胶导致导管断裂。当使用含有2-氰基丙烯酸乙酯的胶水进行儿科硬膜外导管固定时，建议特别注意。
