Caudal ME

Question 1

When does the anatomy change for the sacral Hiatus?***

Answer 1

> 12 yo sacral anatomy and bone growth makes identification and spread of anesthesia less reliable.

After the age of 12 sacral anatomy changes & bone Growth makes identification of the epidural space by this approach and the spread of anesthesia less reliable*

Question 2

The Sacral Hiatus is absent in what percent of adults?**

Answer 2

Sacral hiatus is absent in 8%** of adults preventing entry through the sacrococcygeal ligament into the sacral canal and performing caudal anesthesia

Question 3

What is the Sacral coccygeal ligament?

Answer 3

A combination of the three ligaments above this level

Question 4

How far is the Touhy needle advanced into the epidural space for a caudal?

Answer 4

The Tuohy needle is advanced into the epidural space for a distance of 1 to 3 cm but no further than the 2nd sacral interspace

Question 5

What is the dose for a caudal?

Answer 5

—-In adults the key principle of test dose with 3-mL 1.5 % Lidocaine with 1: 200,000 epi should be followed
—–Only 12-15 mL is necessary for sacral anesthesia
—-20-30 mL for T-10 dermatome
—–Less predictable than with epidural anesthesia-related to variability in volume content and leakage of the caudal canal
—0.5-1mL/Kg
Usually enough for umbilicus level.
—Bupivicaine or Ropivicaine 0.125%-0.5% usually with 1:200k Epi
—Max/Kg dosage still applies

Question 6

What are the complications for a caudal?***

Answer 6

Complications similar to epidural anesthesia*

Question 7

What is the failure rate for caudal blocks?***

Answer 7

10-15% failure rate high*****