safety and efficacy of spinal and caudal anesthesia using ropivacaine for pediatrics surgery: a comparative study

Our objective was to perform comparative study between subarachnoid and caudal epidural anesthesia with ropivacaine in pediatric patients undergoing surgery of the lower half of the body, the study was conducted on 120 patients of both sexes, class I and II of the ASA classification, from birth to 12 years old. All patients were randomly allocated into 3 groups according to age of the patients: Group I: patients are under the age of 3 years. Group II: patients between 3 and 7 years of the age. Group III: patients between 7 and 12 years of the age. Each group was further subdivided into one of 2 groups, the spinal anesthesia group [SAG] [0.5 mg/kg, with maximum dose of 20 mg] after induction of general anesthesia and the caudal anesthesia group [CAG] [0.25%, 1 ml/kg, with maximum dose of 20ml] after induction of general anesthesia. It was observed that, both spinal and caudal block are associated with a significant decrease in the mean values of BP from preoperative values. However, this decrease was clinically insignificant, not shown to depress the respiratory function as evidenced by normal arterial oxygen saturation. No apnea was recorded during the course of the study, and no patients had cardiovascular or neurovascular toxicity in the study. But the spinal block has rapid onset, intense and uniformly distributed / sensory block, good muscle relaxation, less need for inhalation anesthetics than caudal block, but of shorter duration. The study concluded that either spinal or caudal block in children less than 12 years of age [the range of study] is safe, practical and satisfactory in surgery involving lower half of the body provided that the anesthetist is experienced and has an operating room suitably equipped for children and good and well- informed assistant

Complicações e seqüelas neurológicas da anestesia regional realizada em crianças sob anestesia geral: um problema real ou casos esporádicos? / Neurological complications and damage of regional block in children under general anesthesia: a real problem or sporadic cases?

JUSTIFICATIVA E OBJETIVOS: Tem sido discutido se a técnica de anestesia regional em crianças, que na maioria das vezes é realizada após a anestesia geral, é realmente segura. Há o risco potencial de uma lesão neurológica permanente ou temporária quando o paciente não pode informar eventual parestesia ou dor, durante a realização da anestesia regional, o que gera insegurança por parte dos anestesiologistas. O objetivo deste estudo foi avaliar a prevalência de complicações e seqüelas neurológicas da anestesia regional em crianças sob anestesia geral. MÉTODO: Numa análise prospectiva foram estudadas crianças submetidas a intervenções cirúrgicas ortopédica e plástica reparadora sob anestesia regional associada à anestesia geral. A indução e a manutenção da anestesia foram por vias venosa ou inalatória. Após anestesia geral era realizada anestesia regional e avaliada a existência de complicações imediatas, o número de punções realizadas, complicações de médio prazo e presença de seqüelas neurológicas. RESULTADOS: Num período de 13 meses foram estudadas 499 crianças de ambos os sexos, com idade média de 6,7 anos. A maioria dos pacientes foi submetida à anestesia geral associada à peridural lombar ou caudal. A prevalência de complicação imediata foi 3,6 por cento, sendo a mais freqüente o sangramento no momento da punção. A prevalência de complicações em médio prazo foi 1,1 por cento, sendo a mais freqüente a hipoestesia e não houve seqüela neurológica de longo prazo. CONCLUSÕES: Os resultados do presente estudo são concordantes com os de outros autores com relação à baixa prevalência de complicações da anestesia regional em crianças sob anestesia geral, sem deixar seqüelas neurológicas. Isso pode ser atribuído ao uso de material adequado e a experiência da equipe de anestesia.

BACKGROUND AND METHODS: It has been questioned whether regional block in children, which most of the time is done under general anesthesia, is really safe. There is the potential risk of permanent or temporary neurological damage when the patient cannot complain of eventual paresthesia or pain while the block is being performed, making anesthesiologists very insecure. The aim of this study was to evaluate the prevalence of neurological complications and damage of regional block in children under general anesthesia. METHODS: A prospective analysis of children who underwent orthopedic and reconstructive plastic surgeries under regional block associated with general anesthesia was undertaken. Anesthesia was induced and maintained by the intravenous or inhalational route. Regional block was done after general anesthesia and immediate complications, number of punctures, mean term complications, and the presence of neurological damage were evaluated. RESULTS: Four hundred and forty-nine children, boys and girls, with a mean age of 6,7 years, were evaluated over a 13-month period. The majority of the patients underwent general anesthesia associated with epidural lumbar or caudal block. The prevalence of immediate complications was 3.6 percent and bleeding at the time of the puncture was the most frequent complication. The prevalence of average term complications was 1.1 percent, and hyposthesia was the most frequent complication. There was no long-term neurological damage. CONCLUSIONS: The results of this study are similar to those found by other authors regarding the low prevalence of complications of regional block in children under general anesthesia, without the occurrence of permanent neurological damage. This can be attributed to the use of adequate material and the experience of the anesthesia team.

JUSTIFICATIVA Y OBJETIVOS: Han sobrevenido discusiones sobre si la técnica de anestesia regional en niños, que en la mayoría de las veces se realiza después de la anestesia general, sea realmente segura. Existe el riesgo potencial de una lesión neurológica permanente o temporal cuando el paciente no puede informar la eventual parestesia o dolor, durante la realización de la anestesia regional, lo que genera inseguridad por parte de los anestesiólogos. El objetivo de este estudio fue el de evaluar la prevalencia de complicaciones y de secuelas neurológicas de la anestesia regional en niños bajo anestesia general. MÉTODO: En un análisis prospectivo se estudiaron niños sometidos a intervenciones quirúrgicas ortopédica y plástica reparadora bajo anestesia regional asociada a la anestesia general. La inducción y el mantenimiento de la anestesia fueron por vía venosa o por inhalación. Después de la anestesia general se realizaba anestesia regional y se evaluaba la existencia de complicaciones inmediatas, el número de punciones realizadas, complicaciones de medio plazo y la presencia de secuelas neurológicas. RESULTADOS: En un período de 13 meses se estudiaron 499 niños de los dos sexos, con edad promedio entre 6 y 7 años. La mayoría de los pacientes se sometió a la anestesia general asociada a la peridural lumbar o caudal. La prevalencia de complicación inmediata fue de un 3,6 por ciento, siendo la más frecuente el sangramiento al momento de la punción. La prevalencia de complicaciones en medio plazo fue de un 1,1 por ciento, siendo la más frecuente la hipoestesia y no hubo secuela neurológica a largo plazo. CONCLUSIONES: Los resultados del presente estudio están a tono con los de otros autores con relación a la baja prevalencia de complicaciones de la anestesia regional en niños bajo anestesia general, sin dejar secuelas neurológicas. Eso puede ser atribuido al uso de material adecuado y a la experiencia del equipo de anestesia.

Caudal anesthesia in pediatric surgical practice.

Prospective study was carried out on 100 patients since May 2005 in my private practice and in the department of pediatric surgery of MMCH. Under caudal anesthesia along with or without ketaminie induction and gas inhalation all the patients underwent different surgical procedure namely anorectal surgery (eg. anoplasty, rectal polyp), urogenital surgery (Circumcision, hypospadias, meatotomy), groin surgery (hernia, hydrocele) and foot & leg surgery. Calculated dose schedule of drugs used in anesthesia and volume were maintained. Time of giving anesthesia and time of starting analgesia were recorded. Per-operative and postoperative analgesia were evaluated. Every parent was explained regarding the merit of caudal anesthesia calculated and compared with that of general anesthesia. Application of caudal anesthesia with or without ketamine & diazepam induction can be used safely and cost effectively and may be put into protocol in many of the pediatric surgical practice both in institute and also in private practice.

Intoxicación aguda por anestésicos locales: presentación de un caso clínico / Acute intoxication by local anesthetics: a case report

Se describe el caso clínico de una paciente que desarrolló crisis convulsivas clínicotónicas generalizadas como manifestación principal y súbita consecutiva a intoxicación aguda por anestésicos locales al practicarle bloqueo caudal para efectuar tratamiento quirúrgico de enfermedad hemorroidaria. Se describen los factores que influyen para alcanzar concentraciones plasmáticas tóxicas del anestésico local, así como la evolución clínica natural por sobredosificación, pero se recalca que no necesariamente siempre se observan los síntomas citados y que es posible que bruscamente se manifiesten crisis convulsivas o paro cardiaco, por lo cual, el anestesiólogo debe estar preparado para tratar inmediatamente cualquier urgencia y tomar las medidas encaminadas a evitar su progreso.