Optimal Place for Precordial Stethoscope Attachment in Nonintubated Children under Two Years of Age: An Observational Trial

Abstract

Background: The precordial stethoscope is a non-invasive monitoring method in pediatric anesthesia. We previously investigated optimal place for its attachment among intubated children under two years old. Now we also did in nonintubated children under two years old. Methods: Twenty-five patients who underwent general anesthesia in our institution were involved in this study. Lung and heart sounds via precordial stethoscope were recorded (MP3 format) at the six places: Site A (paratracheal region), B (suprasternal notch), C (between place of the nipple and clavicle on the left midclavicular line), D (between place of the costal arch and nipple on the left midclavicular line), E (horizontal level of Site D on the left midaxillary line), and F (epigastric fossa). Two blinded evaluators scored random sorted lung and heart sounds on a 10-point scale (0: cannot hear at all and 10: can hear clearly) individually. Results: Statistically significant differences were observed between Sites A: 10.0 (8.5–10.0), B: 9.0 (2.5–9.5), C: 8.0 (6.5-9.0) and D: 1.5 (1.0–6.5), E: 4.5 (1.5–7.0), F: 1.0 (0.0–4.5) for lung sounds and between Sites B: 9.0 (5.0–10.0), C: 9.5 (8.0–10.0), D: 9.0 (4.5–9.5) and A: 0.0 (0.0–0.0), E: 0.5 (0.0–2.5), F: 0.5 (0.0–0.5) for heart sounds. Conclusion: Site C is the optimal place for precordial stethoscope attachment for children under two years of age during general anesthesia.

Keywords

• Precordial stethoscope
• Lung sound
• Heart sound