hemodialysis on the day before the operation showed he- moglobin 11.3 g/dl, hematocrit 36.3%, glucose 202 mg/dl, Na 136 mmol/L, K 5.2 mmol/L, Cl 97 mmol/L, BUN 43 mg/dl, and creatinine 4.5 mg/dl. Test results on the day of the operation showed that the platelet count and coagu- lation profile (prothrombin time, International Normalized Ratio, activated partial thromboplastin time, fibrinogen) were in the normal ranges. When the patient arrived at the operation room, blood pressure was 135/89 mmHg, and heart rate was 64 bpm. The high level thoracic epidural anesthesia was performed in the sitting position, and an assistant supported both shoulders of the patient so that the patient could lower his head to the maximum (Fig. 1). The first prominent spinous process of the cervical spine, which is the C6 spinous process, was identified [11]. Referring to that, local infiltra - tion of 2% lidocaine 2 ml was performed in the middle line between the T1 and T2 spinous processes. Then, for the loss of resistance technique, a 5 ml glass syringe was con- nected to a 17-G Tuohy needle (ARROWⓇ, Arrow Interna- tional Inc., USA), and the needle was moved to the epidural space by the midline approach. When it moved into the 4.5 cm position from the skin, the plunge of the glass syringe was sucked inside, and the hanging drop method was per- formed at that position. As a result, the epidural space was positively identified, the loss of resistance technique to air was performed to verify that the loss of resistance was positive, and the drip infusion method showed that the SJ Lee, et al / Epidural Catheter Malposition 45 normal saline was dropping at a rate of one drop per sec- ond or higher. After that, an 18-G epidural catheter (ARROWⓇ, Arrow International Inc., USA) was inserted through the Tuohy needle. The epidural catheter was inserted without partic- ular resistance up to 3 cm inside the epidural space. After fixing the catheter, the patient’s position was altered to the supine position, and 1% lidocaine 3 ml containing 1：200,000 epinephrine was injected through the catheter as the test dose. There was no change in blood pressure and heart rate at five minutes after the test injection. The sensory change on both upper arm medial sides was not accurately verified since the patient was unable to cooper- ate well. For epidural anesthesia, a mixture of 0.375% ro- pivacaine 15 ml and fentanyl 50 μg was injected through the epidural catheter. Pin-prick tests at 5, 10, 15 and 20 minutes after drug injection showed that pain had not been alleviated at all, and vital signs were not changed. Judging that the epidural anesthesia failed, general anesthesia was performed under the agreement of the patient. To induce general anesthesia, 2% lidocaine 2 ml- propofol 2 mg/kg-atracurium 0.6 mg/kg was intravenously injected, and the anesthesia was maintained with O2-N2O- desflurane. The operation was carried out for 1.5 hours, and epidural anesthesia failure was reconfirmed when the patient complained of pain in the operated region in the Fig. 1. Sitting position with the neck flexed and arms crossed for thoracic epidural puncture. Fig. 2. Hemodialysis catheter insertion state and median sternotomy state due to CABG. Thin catheter is located in T1-2 intervertebral space, with contrast materials injected in soft tissue failing to demonstrate typical epidurogam.