In Reply:--We thank Lennon for notifying us of the previous report by Nagai et al. [1].

We still consider that neonates may be more prone to accidental dural puncture due to anatomic features, as we stated in our case report. [2].

As the report by Nagai illustrates, a needle, guidewire, dilator, or catheter accidentally inserted or placed in the intrathecal space could cause the neurologic defects by injuring the nerve roots or spinal cord. Therefore, in any attempt at internal jugular cannulation in any patient, caution should be taken to avoid a misinsertion by using a small-gauge pilot needle to locate the vein at an appropriate depth and confirming free venous blood reflux before introduction of a guidewire and catheters.

Yoshikazu Miyamoto, M.D., Department of Anesthesiology, Osaka University Medical School, 2–2 Yamadaoka, Suita, Osaka 565, Japan.

Keiko Kinouchi, M.D., Department of Anesthesiology, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka 590–02, Japan.

(Accepted for publication July 18, 1996.)

Nagai K, Kemmotsu O: An inadvertent insertion of a Swan-Ganz catheter into the intrathecal space. ANESTHESIOLOGY 1985; 62:848-9.
Miyamoto Y, Kinouchi K, Hiramatsu K, Kitamura S: Cervical dural puncture in a neonate: A rare complication of internal jugular venipuncture. ANESTHESIOLOGY 1996; 84:1239-42.