Anesthesia Technologist Practice Exam

Where is an epidural usually placed for children undergoing an orchiopexy?

1. Cervical canal

2. Thoracic spine

3. Sacral hiatus and caudal canal

4. Lumbar region

The correct answer is: Sacral hiatus and caudal canal

The correct placement for an epidural in children undergoing an orchiopexy is typically in the sacral hiatus and caudal canal. This approach is chosen because it allows for effective analgesia while minimizing the risk of complications associated with higher placements. The caudal epidural space is anatomically more favorable for pediatric patients, as it is easier to access and can provide sufficient pain relief for lower abdominal and pelvic surgeries like orchiopexy. Using the sacral hiatus enables anesthesiologists to administer local anesthetics that achieve the desired sensory blockade, particularly targeting the S2-S4 dermatomes, which are relevant for the innervation of the lower abdomen and genital regions. This method also tends to result in fewer side effects and complications compared to higher placements in the lumbar or thoracic regions, where there may be an increased risk of trauma to the spinal cord or nerves. The other locations, such as the cervical canal, thoracic spine, and lumbar region, are less ideal for this type of procedure in children due to potential complications and insufficient coverage for the surgical site, which necessitates the more focused and safer caudal epidural technique.