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[Criteria of recovery from caudal anesthesia in children]
S Saint-Raymond1, F O'Donovan, C Ecoffey
1Département d'Anesthésiologie Hôpital de Bicetre, Université Paris-Sud, le Kremlin-Bicêtre.
Insights
Caudal block with bupivacaine provided effective analgesia for pediatric surgery, but motor function recovery was rapid. Sympathetic nervous system function showed transient changes in heart rate with positional changes.
Area of Science:
- Pediatric Anesthesiology
- Neuroscience
- Pharmacology
Context:
- Caudal epidural blocks are commonly used for pediatric surgical anesthesia.
- Understanding the duration and recovery of sensory, motor, and sympathetic function is crucial for patient management.
Purpose:
- To evaluate the return of sensory, motor, and sympathetic nervous system function after caudal block in children undergoing lower abdominal and urologic surgery.
Summary:
- Twenty pediatric patients (ASA PS I) received caudal blocks with 0.25% bupivacaine. Analgesia was effective in 18/20 children for 4 hours (T10 sensory level). Motor blockade was incomplete and resolved within 4 hours in all patients. Heart rate increased significantly in the upright position, while blood pressure remained stable.
Impact:
- This study highlights the rapid recovery of motor function following caudal blocks in children.
- Findings inform anesthetic management and postoperative care, emphasizing the need for vigilant monitoring of autonomic function during positional changes.
Abstract:
The authors evaluated the return of sensory, motor, and sympathetic nervous system function following caudal block in children. Twenty children, ASA PS I, aged 5 +/- 4 yr (mean +/- SD), weighing 22 +/- 9 kg, scheduled for lower abdominal and urologic surgical procedures were studied. Anaesthesia was induced and maintained by halothane, N2O and oxygen. A caudal block was performed with 1 ml/kg of 0.25% bupivacaine. Analgesia assessed by Broadman's score was efficient in 18 out of the 20 children during the first 4 hours after the block. Upper level of cutaneous analgesia was T10 +/- 2 after the block. Two hours after the caudal injection an incomplete motor blockade was found in 14 of 20 children, and at 4 hours no block was found in any child. Heart rate was significantly increased in the upright position (122 +/- 12 to 131 +/- 26 bpm at 2 hours, and 110 +/- 21 to 118 +/- 28 bpm at 4 hours), whereas arterial blood pressure was unchanged in the upright position.