Probable venous air embolism during caudal anesthesia in a child.

audal anesthesia is a commonly used central block in children because it is easy, effective, C and safe (1). Before injection of the local anesthetic solution, correct placement of the needle may be estimated by feeling a distinct "pop" as the needle punctures the sacrococcygeal membrane (1,2). Negative aspiration, or injection of a test dose containing epinephrine, also may be used to rule out intravenous placement of the needle (2,3). In our institution, it has also been a standard practice to inject a small volume of air through the needle or catheter to exclude the possibility of a subcutaneous injection, which would be detected immediately by palpation. This maneuver has been suggested in recent textbooks as a simple and reliable practice before completion of a caudal anesthesia in a child (4,5). However, we report a case of probable significant venous air embolism (VAE) in a child following air testing before caudal anesthesia.