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Anaesthesia for microvascular surgery in children. A combination of general anaesthesia and axillary plexus block
Insights
Combining general anesthesia with axillary plexus block improves peripheral circulation during prolonged pediatric microvascular toe-to-hand transfers, leading to successful outcomes. This anesthesia technique is safe and effective for complex pediatric reconstructive surgery.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Microsurgery
Background:
- Microvascular reconstructions in children are increasingly successful.
- Optimal surgical conditions are crucial for these complex procedures.
Purpose of the Study:
- To evaluate the combination of general anesthesia and axillary plexus block for microvascular toe-to-hand transfer in children.
- To assess the impact of this anesthesia technique on peripheral circulation and surgical outcomes.
Main Methods:
- Prospective study involving 15 children (1-8 years) undergoing microvascular toe-to-hand transfer.
- Standardized anesthesia using general anesthesia combined with axillary plexus block.
- Monitoring peripheral skin temperature to assess circulation.
Main Results:
- Axillary plexus block increased mean skin temperature in the operated hand by 1.4°C compared to the contralateral extremity.
- Postoperatively, the temperature difference increased to 4.8°C due to vasoconstriction in the control hand (P < 0.01).
- All microvascular transfers survived, with good primary results in most cases; two required reoperations.
Conclusions:
- The combination of general anesthesia and axillary plexus block is a safe and effective anesthesia method for prolonged pediatric microvascular operations.
- Axillary plexus block enhances peripheral circulation in the operated hand, particularly after the cessation of general anesthesia.
- This technique contributes to successful microvascular toe-to-hand transfers in pediatric patients.
Abstract:
Nowadays, microvascular reconstructions are performed with high success rate even in small children. The combination of general anaesthesia and axillary plexus block was used in this prospective study in order to achieve optimal surgical conditions in these challenging operations. Fifteen children under eight years of age (1-8 years) were anaesthetised with a standardised anaesthesia method using a combination of general anaesthesia and axillary plexus block for microvascular toe-to-hand transfer. The duration of anaesthesia varied between 7.5-14.5 hours (mean 11 h). The difference in peripheral skin temperature was used to indicate the difference in peripheral circulation. Due to plexus block, the mean skin temperature in the operated hand was 1.4 degrees C higher than in the opposite extremity at the end of the operation. In the early postoperative phase the temperature difference increased to 4.8 degrees C (P < 0.01) due to vasoconstriction in the control hand. The mean temperature in the transplant was 33.3 +/- 2.4 degrees C at the end of the operation. Primary microvascular results were good in all but two children who needed reoperations. All of the transfers survived. The mean central temperature increased progressively during the operation from 36.2 degrees C to 37.6 degrees C. One 1-year-old child developed a moderate hyperthermia of 39.1 degrees C. According to this study axillary plexus block can be combined with general anaesthesia in prolonged microvascular operations. When the effect of general anaesthesia ceased, the plexus block effectively increased peripheral circulation in the operated hand.