The ‘whoosh’ test and caudal anaesthesia
1998; Wiley; Volume: 53; Issue: 8 Linguagem: Inglês
10.1046/j.1365-2044.1998.0584m.x
ISSN1365-2044
AutoresO. Dearlove, R. W. M. Walker, Jean Yves Bigeon,
Tópico(s)Cardiovascular and Diving-Related Complications
ResumoEastwood et al. (Anaesthesia 1998; 53: 305–7) describe the whoosh test to identify the caudal space and write ‘caudal epidural injection is a simple procedure which carries a low risk of complications’; unfortunately venous air embolism is one of them [1, 2]. Caudal epidural injection is very widely used for analgesia in children but to our knowledge, the whoosh test is not commonly used. On the other hand, one can do a ‘whoosh’ test in children for either lumbar or caudal epidurals, but after considering the papers about venous air embolism, we could not recommend it. Further, in a 10-year retrospective surgery of 24 000 caudals in children, Flandin-Bléty and Barrier [3] described five cases of major neurological damage of which three died and which they said could be ascribed to air embolism, but acknowledge that the causation was not proven. On the other hand, we think Eastwood's data show the test is not much good. He gives two statistics, the sensitivity and specificity. These two figures may be combined to give a positive predictive value — the chance that if the test is positive, the needle is in fact in the right place. Using their data, it is 93% for clinical impression and 96% for the whoosh test, which we would not say is discriminant. The whoosh test has various serious complications and is not discriminant. We would advise our colleagues to use it with the greatest of care.
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