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• W2065202994 abstract "We read with interest the article by Lennox et al, “A Pulsatile Pressure Waveform is a Sensitive Marker for Confirming the Location of the Thoracic Epidural Space.”1Lennox P.H. Umedaly H.S. Grant R.P. et al.A pulsatile pressure waveform is a sensitive marker for confirming the location of the thoracic epidural space.J Cardiothorac Vasc Anesth. 2006; 20: 659-663Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar They concluded that a stiffer multiorificed epidural catheter is better able to transmit pulsations from the epidural space than a single-orifice catheter. They failed to mention our previous work on the subject. In a prospective study of 218 patients undergoing various abdominal and thoracic procedures using the Arrow FlexTip plus catheter (Arrow International Inc, Reading, PA), we found a sensitivity of 81% of the pulsative waveform (what we called epidural pressure wave analysis [EPWA]) after injecting 5 mL of 0.9% saline in the catheter. In our study, level of epidural insertion, median versus paramedian approach, sex, and body mass index did not modify the sensitivity of the EPWA. Age significantly improved the sensitivity from 63% for ages 20 to 39 to 94% for patients 80 and older.2de Médicis E. Tétrault J.P. Martin R. et al.Prospective comparative study of 2 indirect methods of confirming the localization of an epidural catheter for postoperative analgesia.Anesth Analg. 2005; 101: 1830-1834Crossref PubMed Scopus (45) Google Scholar In comparison, Lennox et al1Lennox P.H. Umedaly H.S. Grant R.P. et al.A pulsatile pressure waveform is a sensitive marker for confirming the location of the thoracic epidural space.J Cardiothorac Vasc Anesth. 2006; 20: 659-663Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar found a sensitivity of 55.6% with the Arrow FexTip and 88.9% for the SIMS Portex multiorifice (Smiths Medical MD Inc, St Paul, MN) after an injection of 3 mL of lidocaine (27 patients each). In a second prospective study, we compared the dose-response curve of 3 different catheters (Portex [stiff 3-holes], Portex Duraflex [soft 3-holes], and Arrow Flextip plus [soft 1-hole]). We did find that 3-hole catheters performed better at low volume of injectate, that catheter stiffness did not improve epidural wave transmission, and that increased volume of injectate increased the sensitivity of EPWA. The ideal initial volume to inject through the catheters appeared to be 5 mL.3Pelletier J. de Médicis E. Martin R. et al.Comparative evaluation of three epidural catheters for localization of the epidural space using the epidural pressure waveform.Reg Anesth Pain Med. 2005; 30 (abstr): 583Google Scholar In summary, EPWA or transmission of the epidural pulsatile pressure waveform is improved by the use of 3-hole catheters, higher volume of injectate, and older patients. We do agree that the technique is simple, sensitive, and inexpensive and uses equipment readily available in any operating room. A Pulsatile Pressure Waveform Is a Sensitive Marker for Confirming the Location of the Thoracic Epidural SpaceJournal of Cardiothoracic and Vascular AnesthesiaVol. 20Issue 5PreviewObjectives: The purpose of this study was to assess the validity of using a pulsatile, pressure waveform transduced from the epidural space through an epidural needle or catheter to confirm correct placement for maximal analgesia and to compare 3 different types of catheters’ ability to transduce a waveform.Design: A single-center, prospective, randomized trial.Setting: A tertiary-referral hospital.Participants: Eighty-one patients undergoing posterolateral thoracotomy who required a thoracic epidural catheter for postoperative pain management. Full-Text PDF" @default.
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• W2065202994 date "2007-12-01" @default.
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• W2065202994 title "Additional Information on the Pulsatile Pressure Waveform" @default.
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• W2065202994 doi "https://doi.org/10.1053/j.jvca.2006.11.020" @default.
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