No abstract

The purpose of this review is to evaluate the safety of regional anesthesia techniques performed for postoperative analgesia in anesthetized children. Pediatric regional anesthesia techniques, such as nerve blocks and neuraxial injections of either local anesthetics or narcotics, can potentially reduce postoperative pain for all children undergoing surgery. However, children may react differently to anesthesia than adults, and they usually cannot tolerate the administration of regional anesthesia unless they are under general anesthesia. During a 5-year period (1999-2004) at the Shriners Hospitals for Children Northern California, 2236 regional anesthetic procedures were performed in 1809 patients. All of the regional procedures were performed with patients under general anesthesia. Ninety-one percent (1641) of patients were for orthopaedic extremity or spine surgeries. Patients ranged from 2 months to 20 years old, with 65% (1169) between the ages of 6 months and 12 years. One thousand eleven procedures were lower extremity blocks, 646 were upper extremity blocks, and 579 were neuraxial injections. Four hundred fifty-four peripheral nerve blocks were performed in patients aged 3 years or younger. Two self-limiting complications possibly related to peripheral nerve blocks were noted. No complications were noted in patients who received neuraxial injections. This retrospective review indicates that regional anesthesia techniques performed 'under general anesthesia have a low rate of complications in children. A prospective trial is recommended to establish the efficacy and safety of this practice.

There have been several case reports of seizure-like activity associated with fentanyl (1-3) and sufentanil ( 6 6 ) during induction of anesthesia as well as postoperatively (7). As yet there have been no reports of such activity described with alfentanil. Case ReportA 60-year-old, 70-kg male was scheduled for an L P 5 laminectomyldiscectomy. He had a history of atherosclerotic heart disease with prior myocardial infarction in 1981 and stable angina. He also had a history of atherosclerotic peripheral vascular disease with prior abdominal aortic aneurysm repair in 1982. His medications included propranolol, dipyridamole, isosorbide, and diazepam. He had no prior history of a seizure disorder or other neurologic disease. Except for a slightly decreased left patellar tendon reflex and back tenderness, his physicaI examination was within normal limits.The patient was given his usual cardiac medications plus, one hour prior to surgery, metoclopramide 10 mg, ranitidine 150 mg and diazepam 5 mg. He also received 1 mg of midazolam iv just prior to entering the operating room. He was monitored with an EKG, an automated sphygmomanometer, a precordial stethoscope, and a pulse oximeter prior to, during, and after induction of the anesthesia. Following the preoxygenation, he was given 1500 Fg of alfentanil(25 pglkg) over 30 seconds. He developed a tremor in the right arm, and then in the left arm, followed by coarse jerking movements of both legs. The movement became progressively more rhythmic and coarse. Then his eyes rolled up and he became