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An observational study of the macro- and micro-haemodynamic implications of epidural anaesthesia in children
L Triffterer1, P Marhofer1, G Lechner2
1Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
Insights
Epidural anesthesia in children significantly impacts cardiac output and stroke volume, but maintains brain and kidney oxygenation. This study provides crucial hemodynamic data for pediatric anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Cardiovascular Physiology
Background:
- Hemodynamic effects of epidural anesthesia in pediatric patients are not well-established.
- Limited data exists on macro- and micro-circulatory changes during pediatric epidural anesthesia.
Purpose of the Study:
- To investigate the macro- and micro-hemodynamic implications of epidural anesthesia in children.
- To assess changes in cardiac output, systemic vascular resistance, and organ oxygenation post-epidural blockade.
Main Methods:
- Observational study of 25 children (neonates to 6 years) undergoing surgery with epidural anesthesia.
- Macrohemodynamic parameters (cardiac output, stroke volume, systemic vascular resistance) monitored using LiDCOrapid.
- Microhemodynamic parameters (cerebral and peri-renal oxygenation) monitored using Invos™.
Main Results:
- Significant increases in cardiac output (p=0.009) and stroke volume (p=0.006) observed approximately 30 minutes after epidural blockade.
- Significant decrease in systemic vascular resistance (p=0.007) noted.
- No significant changes in heart rate, arterial pressure, or cerebral/peri-renal oxygenation were detected.
Conclusions:
- Epidural anesthesia in children causes significant macrohemodynamic alterations.
- Cerebral and peri-renal autoregulation is maintained despite macrohemodynamic changes.
- This suggests epidural anesthesia is safe regarding organ perfusion in pediatric patients.
Abstract:
The haemodynamic implications of epidural anaesthesia in children are poorly documented. We report macro- and micro-haemodynamic data from an observational study of 25 children ranging from neonates to six-years old, who underwent surgery conducted with a specific combination of monitoring systems. We analysed 90 min of study-related monitoring after epidural catheterisation, with skin incision taking place after around 30 min. We recorded macrohaemodynamic parameters (monitored using LiDCOrapid) including heart rate, mean arterial pressure, cardiac output, stroke volume, systemic vascular resistance and stroke volume variation. Microhaemodynamic parameters (monitored using Invos™) included cerebral and peri-renal oxygenation. Based on the entire 90 min of study-related monitoring, we found significant increases in cardiac output (p = 0.009), stroke volume (p = 0.006) and stroke volume variation (p = 0.008), as well as decreases in systemic vascular resistance (p = 0.007) around 30 min after epidural blockade. There were no significant changes in heart rate, arterial pressure and cerebral or peri-renal oxygenation during these 90 min. Considering that the microhaemodynamic parameters were not affected by the macrohaemodynamic changes, we conclude that autoregulation of the brain and the kidneys was maintained in children under epidural anaesthesia.
