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[Diprivan and locoregional anesthesia in children over 3 years of age]
1Département d'Anesthésie, Hôtel-Dieu, Clermont-Ferrand.
Insights
This study outlines a pediatric anesthesia protocol using propofol infusion for surgical blocks. It ensures rapid recovery and minimal side effects, facilitating same-day discharge for pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Context:
- Optimizing anesthesia for pediatric surgical procedures.
- Addressing challenges in pediatric venous access and patient distress.
- Evaluating propofol-based anesthesia for regional blocks in children.
Purpose:
- To describe a comprehensive anesthetic preparation and maintenance protocol for pediatric patients undergoing regional blocks.
- To detail the induction, maintenance, and recovery phases of anesthesia.
- To highlight the safety and efficacy of propofol infusion and halogenated agents in pediatric anesthesia.
Summary:
- The protocol involves topical anesthesia, optional midazolam premedication, and intravenous propofol induction (3-4 mg/kg) with lidocaine.
- Maintenance anesthesia utilizes a propofol infusion (13 mg/kg/h bolus, then 2-5 mg/kg/h) or low-concentration halogenated agents.
- The technique emphasizes careful patient positioning and the use of concentrated local anesthetics to prevent differential blocks, ensuring rapid, pleasant recovery with minimal side effects.
Impact:
- Facilitates efficient and safe anesthesia management in pediatric surgical settings.
- Contributes to a reduction in post-anesthetic complications and improved patient experience.
- Supports the feasibility of day-case surgery for pediatric patients, minimizing hospital stays.
Abstract:
Preparation for anaesthesia (at least 1 hour prior to surgery): Topical anaesthesia at venepuncture sites and at the site of the block. Possible premedication (rectal midazolam: 0.3 mg.kg-1). Anaesthetic induction: Insertion of venous cannula; i.v. injection of 3-4 mg.kg-1 propofol, mixed with 0.05% lidocaine; Control of child's ventilation conditions: tolerance of the face mask, Guedel airway, laryngeal mask; tracheal intubation would be easy if necessary and would not require muscle relaxants; In cases where the child is distressed or where venous access cannot be obtained, it is sometimes preferable to resort to inhalational induction with halogenated anaesthetics prior to venepuncture. Initial maintenance anaesthesia (performing the block): Propofol given as a continuous infusion of 13 mg.kg-1.h-1, after a bolus injection of 1.3 mg.kg-1 (alternative solution: maintaining anaesthesia using halogenated agents); Positioning of the patient and performing the block technique with relatively concentrated local anaesthetic solutions (to avoid differential blocks). Maintenance anaesthesia during the procedure: Propofol given as a continuous infusion in reduced doses: 2 to 5 mg.kg-1.h-1; Alternatively: halogenated anaesthesia at low concentrations (equivalent to 0.25 to 0.5 vol % of halothane). Recovery: Particularly rapid and pleasant recovery, with a minimum of side effects; In cases of day-case surgery, patient discharge has virtually never to be postponed.