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Age-based Local Anesthetic Dosing in Pediatric Spinal Anesthesia: Evaluation of a New Formula - A Pilot Study in
S Parthasarathy1, T Senthilkumar1
1Department of Anesthesiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India.
Insights
This pilot study shows that an age-based spinal anesthesia dose (age/5) of hyperbaric bupivacaine is effective and safe for pediatric infra-umbilical surgeries. No complications were observed in this study of 25 children.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Pharmacology
Background:
- Spinal anesthesia offers a safe alternative to general anesthesia for pediatric lower abdominal and limb surgeries.
- Age-based dosing is considered due to varied vertebral growth patterns in children.
- The study aimed to evaluate an age-based hyperbaric bupivacaine dosage for spinal anesthesia in pediatric patients.
Purpose of the Study:
- To determine the efficacy of an age-based dosing schedule of hyperbaric bupivacaine for spinal anesthesia in children undergoing infra-umbilical surgeries.
- To assess the safety and identify any complications associated with this age-based anesthetic regimen.
Main Methods:
- A cohort of 25 pediatric patients (2-12 years) received spinal anesthesia with hyperbaric bupivacaine dosed at age/5.
- Preoperative sedation was administered using pentazocine, midazolam, and atropine.
- Data collected included attempts for administration, onset, sensory level, duration, and complications.
Main Results:
- Spinal anesthesia was successful on the first attempt in 88% of cases.
- The mean sensory level achieved was T8.5, with surgery completed within approximately 60 minutes.
- No intra-operative complications or conversions to general anesthesia were reported; three patients required additional sedation.
Conclusions:
- An age-based (age/5) hyperbaric bupivacaine spinal anesthetic regimen is a successful and safe technique for pediatric infra-umbilical surgeries.
- The study demonstrated no observed complications, supporting the use of this novel dosing formula in Indian children.
- This pilot study provides evidence for the efficacy of age-adjusted spinal anesthesia in pediatric surgical procedures.
Background:
Spinal anesthesia is a safe alternative to general anesthesia and often the anesthetic technique of choice in many lower abdominal and lower limb surgeries in children. As the vertebral column and spinal cord grows variedly with age and not weight, we planned to administer an age-based dosing schedule of hyperbaric bupivacaine in the intra-thecal space in select infra umbilical surgeries in children. The aim was to find out the efficacy and complications associated with this dosage.
Methodology:
Twenty-five pediatric patients between 2 and 12 years, posted for elective infra umbilical surgeries were given a sedation as a combination of effective doses of pentazocine, midazolam, and atropine. In all those patients, spinal anesthesia was administered at a dose of age/5 of hyperbaric bupivacaine. The number of attempts, the onset of blockade, the mean sensory level, and the duration of anesthesia were noted. Any other complications were also noted.
Results:
The mean and standard deviation of age is 7.68 ± 2.49 years. Intra-thecal anesthesia was administered successfully in the first attempt in 88% of cases whereas the remaining needed the second attempt. Three patients needed intravenous ketamine of 0.25 mg/kg additionally for preoperative sedation. The sensory level was between T6 and T10 with a mean of T8.5. There were no intra-operative complications. In all patients, surgery was finished within the duration of anesthesia of approximately 60 min. There was no conversion to general anesthesia in any case, but a three patients required dose of 0.25 mg/kg of intravenous ketamine as a calming dose.
Conclusion:
Administration of age-based local anesthetic dosing of hyperbaric bupivacaine in the intra-thecal space by utilizing a new formula of age/5 (Partha formula) is successful in a pilot study in Indian children for infra-umbilical surgeries. There were no observed complications.
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