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Evaluation of caudal anaesthesia performed in conscious ex-premature infants for inguinal herniotomies
J C Bouchut1, R Dubois, C Foussat
1Department of Anaesthesiology and Intensive Care, Edouard Herriot Hospital, Lyon, France.
Insights
Caudal epidural anesthesia in awake, ex-premature infants undergoing surgery is safe and effective. This method simplifies postoperative care and reduces apnea risk, though it requires skilled practitioners.
Area of Science:
- Pediatric Anesthesiology
- Neonatal Surgery
Background:
- Ex-premature infants (before 45 weeks postconceptional age) face high apnea risk post-surgery.
- General anesthesia elevates this apnea risk in vulnerable infants.
Purpose of the Study:
- To evaluate the safety and efficacy of caudal anesthesia in conscious ex-premature infants.
- To assess patient comfort and postoperative complications.
Main Methods:
- Caudal anesthesia was performed on 25 consecutive, awake ex-premature infants for inguinal herniotomy.
- Nitrous oxide/oxygen and EMLA cream were used to aid caudal puncture.
- Anesthesia procedure, patient comfort, and 24-hour postoperative complications were monitored.
Main Results:
- Good anesthesia conditions were achieved with minimal compromise to infant comfort.
- Few perioperative complications were observed; only two infants with prior apnea history experienced apnea.
- One infant experienced total spinal anesthesia, and another required general anesthesia due to prolonged surgery.
Conclusions:
- Caudal epidural anesthesia in awake, high-risk preterm infants is beneficial, simplifying postoperative management.
- The technique does not negatively impact surgical conditions.
- Successful implementation requires experienced anesthesiologists.
Abstract:
Ex-premature infants, before 45 weeks postconceptional age, are at high-risk of apnoea after surgery. General anaesthesia increases the risk of apnoea. We evaluated the tolerance and the efficiency of caudal anaesthesia performed in 25 consecutive conscious ex-premature infants for inguinal herniotomies. N2O/O2 and EMLA cream are used to facilitate caudal puncture. Anaesthesia procedure, patient comfort and complications following the 24 postoperative hours were studied. We report good anaesthesia conditions without compromising the baby's comfort and few perioperative complications. Only two infants with a prior history of apnoea or bronchopulmonary dysplasia had apnoea during and after surgery. A total spinal anaesthesia was the major complication in one infant and prolonged surgery requiring general anaesthesia was the main limitation of this technique in another child. The principal advantage of the procedure is to facilitate and simplify the postoperative management of the babies. The anaesthetic technique does not alter surgical conditions. Caudal epidural anaesthesia performed in awake high-risk preterm infants is beneficial for these infants but requires experienced operators.