ABSTRACT
OBJECTIVE Minimal literature exists on the intraoperative complication rate of pediatric neurosurgical procedures with respect to both surgical and anesthesiological complications. The aim of this study, therefore, was to establish intraoperative complication rates to provide patients and parents with information on which to base their informed consent and to establish a baseline for further targeted improvement of pediatric neurosurgical care. METHODS A clinical complication registration database comprising a consecutive cohort of all pediatric neurosurgical procedures carried out in a general neurosurgical department from January 1, 2004, until July 1, 2012, was analyzed. During the study period, 1807 procedures were performed on patients below the age of 17 years. RESULTS Sixty-four intraoperative complications occurred in 62 patients (3.5% of procedures). Intraoperative mortality was 0.17% (n = 3). Seventy-eight percent of the complications (n = 50) were related to the neurosurgical procedures, whereas 22% (n = 14) were due to anesthesiology. The highest intraoperative complication rates were for cerebrovascular surgery (7.7%) and tumor surgery (7.4%). The most frequently occurring complications were cerebrovascular complications (33%). CONCLUSIONS Intraoperative complications are not exceptional during pediatric neurosurgical procedures. Awareness of these complications is the first step in preventing them.
Subject(s)
Neurosurgical Procedures/adverse effects , Neurosurgical Procedures/mortality , Anesthesia/adverse effects , Anesthesia/mortality , Child , Child, Preschool , Databases, Factual , Humans , Infant , Prospective StudiesABSTRACT
INTRODUCTION: The Episure Autodetect syringe, a spring-loaded syringe, is a loss-of-resistance syringe with an internal compression that applies constant pressure on the plunger. As the principle of loss-of-resistance is the same for adult and for pediatric patients, the Episure Autodetect syringe should be able to identify correctly the epidural space also in pediatric patients. METHODS: A retrospective review was carried out for all pediatric patients, in which the Episure Autodetect syringe was used for locating the epidural space between 2007 and 2011 in our department. RESULTS: In 17 pediatric patients (9 months-14 years, 7.5-43 kg weight), the Episure syringe was used. In all 17 patients, the epidural space was correctly identified using the spring-loaded syringe as evidenced by satisfactory analgesia. No accidental dural punctures or false loss-of-resistances were observed. CONCLUSION: The spring-loaded Episure Autodetect syringe might be a potentially useful loss-of-resistance syringe for identification of the epidural space in pediatric patients.
Subject(s)
Anesthesia, Epidural/instrumentation , Anesthesia, Epidural/methods , Epidural Space/anatomy & histology , Syringes , Adolescent , Anesthesia, Inhalation , Anesthesia, Intravenous , Anesthetics, Local , Bupivacaine , Child , Child, Preschool , Epinephrine , Female , Humans , Infant , Injections , Laparotomy , Male , Preanesthetic Medication , Retrospective Studies , Thoracic Surgical Procedures , Vasoconstrictor AgentsABSTRACT
Ultrasound-guided interscalene brachial plexus block is described in a 7-year-old child with femur fibula ulna syndrome. It is suggested that ultrasound is a useful tool in situations where nerve stimulation for nerve localization cannot be used.
Subject(s)
Brachial Plexus , Femur/abnormalities , Fibula/abnormalities , Humerus/surgery , Ulna/abnormalities , Ultrasonography, Interventional , Child , Female , Humans , Nerve Block/methods , SyndromeABSTRACT
BACKGROUND: Brachial plexus blockade is a well-established technique in upper limb surgery. Among the infraclavicular approaches, the vertical infraclavicular brachial plexus (VIP) block is easy to perform and has a large spectrum of nerve blockade. The aim of this preliminary study was to determine the ease, effectiveness, safety, and duration of the VIP block in pediatric trauma surgery. METHODS: Fifty-five patients (ASA physical status I and II, age range 5-17 years old) scheduled for upper limb trauma surgery received a VIP block under light general anesthesia, using 0.5 ml x kg(-1) of ropivacaine 0.5%. The number of attempts and time to perform the block, the occurrence of a surgical response, the visual analogue score (VAS) scores, the incidence of complications and the duration of the block were evaluated. RESULTS: The brachial plexus was found easily at the first or second attempt in 85% (47 of 55) of the cases, in 15% (eight of 55) of the cases it was localized after three to four attempts. The mean time to perform the block was 3.35 +/- 3.37 min. Ninety-eight percentage (54 of 55) of the blockades were effective for surgery and in just one case was ineffective. The VAS scores at the end of the procedure in 100% (55 of 55) of the cases were <3. There were no cases with clinical signs of pneumothorax nor inadvertent puncture of major vessels. Two patients developed a Horner's syndrome and in one a mild superficial hematoma at the puncture site occurred. The mean sensory block duration was 8.45 +/- 1.71 h and the mean motor block duration was 6.52 +/- 2.50 h. CONCLUSIONS: In this preliminary study, the VIP block was easy to perform, effective and free of major complications for pediatric trauma surgery. With the doses of ropivacaine we used it was useful for intra- and postoperative analgesia.
