Paediatric neuraxial anaesthesia asleep or awake, what is the best for safety?

摘要

The target of this prospective randomized double blind study was to evaluate the safety in asleep paediatrics.Patients and methods: Children were randomly assigned into two equal groups. In one group (the epidural group) combined lumbar epidural analgesia and general anaesthesia was given, while in the second group, spinal anaesthesia was given (spinal group). In both groups the neuraxial block were given in lateral position in asleep paediatric patients after complete aseptic technique.Results: asleep neuraxial block revealed no major complications in the form of spinal cord haematoma, epidural abscess, paraplegia, parathesia, or systemic local anaesthetic toxicity in paediatric patients subjected to neuraxial block.Conclusion: We can conclude that,neuraxial anaesthesia in asleep paediatrics patient may be safer and easier than in awake children provided that an expertise anesthesiologist adheres to these principles. Introduction The basics of the technique of neuraxial regional anaesthesia were applied mainly for adults. Recently paediatric neuraxial anaesthesia especially spinal anaesthesia is appearing to gain more popularity than before. in awake patients, feeling of parathesia during needle placement, pain during drug injection, in addition to catching of the early manifestations of systemic local anaesthetic toxicity is one of the important protective symptoms to avoid these neuraxial anaesthetic complications. Although neuraxial anaesthesia is rarely used as a single anaesthetic technique for surgical procedures in paediatric patients, it is now being commonly used in combination with general anaesthesia. The concept of this combination is the reduction of the total amount of both intravenous and /or inhalational anaesthetic agents which decrease their side effects, help in rapid recovery, and emergence from anaesthesia in this fragile group of patients. Also regional anaesthesia provides analgesia for the postoperative period which is very advantageous. The target of this study was to evaluate the degree of neurological injuries or systemic toxicity complications of neuraxial anaesthesia in asleep paediatrics. Patients and methods After approval of the study protocol from the responsible authorities and a written informed consent taken from parents, 120 paediatric patients (age 2-8years) admitted to Urology and Nephrology Center, Mansoura University for various infraumblical urologic procedures (expected time less than 2 hours) classified ASA 1 and 2 were included in this Study. Contraindications for neuraxial anaesthesia were respected and considered as exclusion criteria to this study. Children were randomly assigned into two equal groups using computer generated randomized test. In one group (the epidural group) combined lumbar epidural analgesia and general anaesthesia was given, while in the second group, spinal anaesthesia was given (spinal group). In both groups the neuraxial block were given in lateral position in asleep paediatric patients after complete aseptic technique. In the waiting area and immediately before shifting them to the operation room, all children were given sedation by administration of intravenous midazolam 20 microgram per Kg, atropine sulphate 10 microgram per Kg and ketamine .25 mg per Kg.On arrival to the operation room all children were monitored with peripheral oxygen saturation, noninvasive arterial blood pressure measurement, and 5 leads ECG. In addition to measurement of the endtidal carbon dioxide tension in the epidural group.In the spinal group sedation was maintained with minimal concentration of isoflorane ~0.2% that was administered through air enriched/oxygen face mask. After complete aseptic technique and local anaesthetic lidocaine 1% skin infiltration, spinal anaesthesia was given using the trocar of 22 G IV catheter over needle . 0.5% hyperbaric bupivacaine (0.4 mg /Kg) was injected into L4-L5 or L5-S1 space. In the epidural group, propofol 1.5mg/Kg, fentanyl 0.5 microgr