Caudal anesthesia in a patient with severe pulmonary hypertension.

Delivery of anesthesia to patients with severe pulmonary hypertension can be extremely challenging. The profound hemodynamic alterations of the disease can often be exacerbated by alterations in circulatory function brought about by anesthetic and surgical interventions. High perioperative morbidity and mortality rates have been reported. Minimizing adverse outcomes in these patients requires careful perioperative evaluation and planning. Selection of an anesthetic technique suitable for the surgery without causing major hemodynamic alterations, which can lead to cardiac failure and death, is a unique consideration of the anesthesia provider. As shown in this case report, caudal anesthesia, when appropriate, can offer a safe anesthetic for these patients.

Beneficial effects of the combined techniques of caudal and general anesthesia in the pediatric patient: two case reports.

The practice of combining a caudal anesthetic with a general anesthetic is frequently used in the management of pediatric patients. The principal advantage is improved postoperative pain management. Additionally, the perioperative reduction of inhalation agents as well as narcotic and non-narcotic analgesics provides a faster, more pleasant recovery from anesthesia that may result in a shorter hospital stay. The addition of caudally administered narcotics provides superior postoperative pain management in the pediatric patient requiring prolonged hospitalization. This article examines this combined technique in two pediatric patients: one, an ambulatory patient, the second, a patient requiring a postoperative intensive care admission.