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[Gastroesophageal reflux with combined caudal and halothane anesthesia in children]
1Service de Néphrologie, Centre Hospitalier Lyon-Sud, Pierre-Bénite.
Insights
This study found that combined halothane and caudal anesthesia in children undergoing lower abdominal surgery resulted in minimal gastroesophageal reflux. Two brief, asymptomatic reflux episodes occurred, with no adverse respiratory or hemodynamic effects observed.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Surgical Safety
Context:
- Assessing gastroesophageal reflux (GER) in pediatric patients undergoing surgery.
- Evaluating the safety and efficacy of combined halothane and caudal anesthesia.
- Monitoring GER during and after surgical procedures in children aged 2-5 years.
Purpose:
- To investigate the incidence and characteristics of gastroesophageal reflux during combined halothane and caudal anesthesia in pediatric patients.
- To assess the respiratory and hemodynamic stability during this anesthetic technique.
- To determine the safety of this anesthetic approach for surgeries below the umbilicus.
Summary:
- Sixteen pediatric patients (ASA 1, aged 2-5 years) undergoing infraumbilical surgery were monitored for GER using a pH probe during halothane anesthesia combined with caudal anesthesia.
- Two asymptomatic GER episodes were detected, one during caudal catheter insertion and another during recovery, lasting 4-7 minutes.
- No respiratory complications or significant hemodynamic instability were observed throughout the procedure.
Impact:
- The combined halothane and caudal anesthesia technique appears safe for pediatric surgeries below the umbilicus, with a low incidence of GER.
- This study highlights the importance of careful patient handling and anesthetic depth to minimize GER episodes.
- Provides valuable data for anesthesiologists on the safety profile of this anesthetic combination in pediatric surgical populations.
Abstract:
Sixteen children, aged 2 to 5 years and ranked ASA 1, were included in this study assessing gastro-oesophageal reflux occurring under halothane anaesthesia, before and during, caudal anaesthesia. They were scheduled for surgery below the umbilicus lasting 1 to 5 h. After premedication with oral hydroxyzine (2 mg.kg-1) and intravenous atropine (10 micrograms.kg-1), induction was carried out with 3% halothane. A gastro-oesophageal pH probe was inserted via the nose after calibration at 37 degrees C. A neutral pH for the oesophageal electrode and an acid pH for the gastric one demonstrated the correct position of the probe. The pH was then registered every 4 s. The probe was left in situ until the patient left the recovery room. The caudal anaesthesia catheter was then inserted with the patient lying on his left side. Caudal anaesthesia was began with 2.5 mg.kg-1 of plain bupivacaine and 5 mg.kg-1 of plain lidocaine. When the patient was lying supine again, narcosis was maintained with 0.5% halothane and 50% nitrous oxide. A dose of 1.5 mg.kg-1 of bupivacaine was injected every 30 to 45 min. None of the children displayed any respiratory signs (coughing, dyspnoea, bronchospasm, cyanosis) during the combined anaesthetic. Two episodes of asymptomatic gastro-oesophageal reflux were revealed by this method, one lasting 7 minutes and occurring during insertion of the caudal catheter, and the other, lasting 4 minutes, during recovery. There were no pulmonary sequels. There was excellent respiratory and haemodynamic stability throughout. The two episodes seemed to have been triggered off by rapid displacement of the patient and too deep an anaesthetic.(ABSTRACT TRUNCATED AT 250 WORDS)