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[Dose requirement for caudal anesthesia in pediatric patient]
Insights
Caudal anesthesia with mepivacaine is a safe and effective method for pediatric surgical analgesia. Body weight is a reliable parameter for determining anesthetic dosage in children.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Context:
- Caudal anesthesia is frequently used in pediatric surgery.
- Determining appropriate anesthetic dosage is crucial for patient safety and efficacy.
Purpose:
- To evaluate the safety and efficacy of caudal anesthesia using mepivacaine in a large cohort of pediatric patients.
- To identify reliable parameters for anesthetic dose calculation in infants and children.
Summary:
- A study of 305 pediatric patients (1 day to 14 years) utilized caudal anesthesia with mepivacaine.
- Anesthetic doses were adjusted based on the desired anesthesia level (T10, L1, S).
- Complete failure occurred in 4.3% of cases; one infant experienced apnea and bradycardia, managed successfully.
- Mepivacaine blood concentrations ranged from 0.5 to 5.0 microgram/mL.
- High correlation was found between the C7-sacral hiatus distance and height (r=0.97) and body weight (r=0.93), confirming body weight as a reliable parameter for dose determination.
Impact:
- Establishes caudal anesthesia with mepivacaine as a safe, reliable, and simple technique for pediatric surgical analgesia.
- Provides evidence supporting the use of body weight for accurate anesthetic dosing in pediatric patients.
- Contributes to improved anesthetic management and patient outcomes in pediatric surgery.
Abstract:
A series of 305 infants and children between 1 day to 14 years of age were operated upon using caudal anesthesia. We used 1% mepivacaine 1.2 ml.kg-1 to obtain a level of anesthesia above T10, 1.0 ml.kg-1 above L1, and 0.8 ml.kg-1 above S. Complete failure occurred in 4.3% of patients. We investigated the blood concentration of mepivacaine in 17 patients, and it ranged from 0.5 microgram.ml-1 to 5.0 micrograms.ml-1. In a two month old infant, weighing 6.7 kg, apnea and bradycardia occurred. This was managed by tracheal intubation and controlled ventilation. But there were no other severe complications. We also investigated the distance between C7 and sacral hiatus (D) in each case. The coefficients of correlation between D and height is 0.97, and high correlation existed also between D and body weight (r = 0.93). This confirms that body weight can be used as a parameter to determine the dose of local anesthetic agent. We conclude that this technique is a safe, reliable and simple way to produce surgical analgesia in infants and children.