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Ana Pinto Carneiro1, Margarida Gonçalves1, Joana Marques1, Ivanete Peixer2, Teresa Cenicante2, Teresa Rocha3

1- Interno de Anestesiologia, Centro Hospitalar de Lisboa Central
2- Assistente Hospitalar Graduado, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central
3- Chefe de Serviço, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central

 - Reunião Internacional 33 Annual ESRA Congress 2014 - Sevilha
- Poster

Regional anesthesia is usually performed in children under general anesthesia (GA)/sedation. Inadvertent intravascular placement is a known complication of neuroaxial anesthesia/analgesia. If unrecognized may cause severe complications.
We report a case of a 1 month-year-old child in whom an intravascular placement of the catheter was noted.
Case report
A child aged 1 month with the diagnosis of malrotation was presented for an exploratory laparotomy. A caudal epidural with catheter was performed. There was no gravity free flow of blood neither blood aspirated and a 0,2%ropivacaine bolus was administered. During the surgery heart rate increased intermittently and another local anesthetic (LA) bolus was administered through the catheter, preceded by negative aspiration. At the end of the surgery a ropivacaine perfusion was initiated. A systemic inadequate perfusion was perceived by low pulse oximetry and cold mottled skin.
We suspended the perfusion and performed another aspiration test which was positive this time. The catheter was removed and the child fully recovered with no sequelae.
The catheter was placed uneventfully, without suggestion of intravascular location. Migrations of catheters to blood vessels have been described and could be an explanation. During surgery tachycardia suggested that the catheter was not optimally placed and it could be already intravascular. Since GA may mask the symptoms of intravascular injection of LA and it is difficult to assess motor block in infants, the use of a test dose does not guarantee the correct placement of a catheter and we don’t routinely perform it. Test dose in infants remains controversial.

Palavras Chave: local anesthetic, toxicity, test dose