To the Editor:--Recently, Miyamoto et al. described inadvertent dural puncture with a 22-gauge needle during right internal jugular vein (IJV) cannulation in an infant. [1]No neurologic injury is described. The authors appear to be unaware of a previous (and more frightening) report by Nagai et al. that describes inadvertent dural puncture with a 16-gauge needle during right IJV cannulation and subsequent intrathecal placement of a pulmonary artery catheter in an adult. [2]In that patient, a neurologic deficit (T1-T3 hypoalgesia) appeared but resolved within 3 days. Readers should be made aware of this prior report, lest they infer that infants are more prone to dural puncture during IJV cannulation or that associated neurologic injury has not been reported.

Paul Lennon, M.D., Department of Anesthesia, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115.

(Accepted for publication July 12, 1996.)

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.
Nagai K, Kemmotsu O: An inadvertent insertion of a Swan-Ganz catheter into the intrathecal space. ANESTHESIOLOGY 1985; 62:848-9.