A reply

Résumé fourni par la source

We are grateful for the opportunity to reply to the letter by Drs Collier and Gatt commenting on our study (Carrie and Russell. Anaesthesia 2000; 55: 1231–3), although regret the need to defend our findings. The whole point of reporting the study was to demonstrate the remarkable ability of epidural catheters to loop in the soft tissues of the back, thus explaining the phenomenon of continuous epidurals becoming ineffective while apparently unmoved at skin level. Whatever Collier and Gatt's difficulties may be in visualising their epidural catheters radiologically, we had no such problems, the catheters being perfectly clear to junior anaesthetists and midwives looking at the films. Their extraordinary suggestion that we had imagined the catheter images and that our ‘representations of gently looping catheters are artefactual’ would negate the whole point of our report and comes dangerously close to questioning our professional integrity. The ‘clear white lines’ which we drew on the X-rays were to indicate the paths of the catheters, which unfortunately were not so obvious when greatly reduced in size and reproduced for publication. We would repeat our conclusion that if fixed firmly to the skin, epidural catheters may cease to function due to their ability to be pulled out of epidural space and loop in the soft tissues of the back. Consequently, a catheter such as that designed by Collier and Gatt in which the three lateral eyes lie within 4 mm of the tip is potentially advantageous when compared with one where the lateral eyes are more proximal. The typographic error that converted ‘Gatt’ to ‘Gaff’ was not under our control. The spelling was correct in the manuscript submitted to Anaesthesia, but as readers are probably aware, correspondents are not given the opportunity to see proofs of their letters before publication.

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