Caudal anaesthesia under sedation: a prospective analysis of 512 infants and children

Area of Science:

• Pediatric Anesthesiology
• Regional Anesthesia Techniques
• Surgical Patient Safety

Background:

• Caudal anesthesia is common for pediatric subumbilical surgery, often combined with general anesthesia.
• General anesthesia carries a significant risk of postoperative apnea, particularly in preterm infants or those under 46 weeks post-conceptual age.
• Sedated, spontaneously breathing patients may benefit from caudal block as a safer alternative.

Purpose of the Study:

• To evaluate the safety and efficacy of caudal anesthesia performed under sedation in pediatric patients.
• To compare adverse event rates in preterm versus term infants and in infants versus children undergoing caudal block.
• To assess the correlation between adverse events and factors like continuous sedation, comorbidities, and ASA classification.

Main Methods:

• A study involving 512 infants and children undergoing caudal anesthesia.
• Sedation protocol included midazolam, nalbuphine, and propofol.
• Caudal block administered using ropivacaine (0.2% or 0.35%).

Main Results:

• Caudal block success rate was 98.05% with an overall adverse event rate of 7.03%.
• No significant difference in adverse events was observed between preterm and term infants, or between infants and children.
• No correlation found between adverse events and continuous sedation, comorbidities, or ASA classification.

Conclusions:

• Caudal anesthesia under sedation demonstrates high success rates and a low incidence of adverse events in pediatric patients.
• This technique offers a potentially safer alternative to general anesthesia for specific pediatric surgical procedures.
• Careful perioperative management is essential for optimizing outcomes with caudal anesthesia in sedated children.