Anaesthesia for microvascular surgery in children

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.

A new brachial plexus block technique in dogs

“…The relative rates of recovery of motor activity and sensation were not tested in this study. This technique was associated with a long‐lasting analgesic effect as reported in other studies (Brandl & Taeger 1991; Urban & Urquhart 1994; Inberg et al. 1995).…”

“…The brachial plexus block, when appropriately performed, should not cause any limb damage (Dorman et al. 1994; Inberg et al. 1995).…”

Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer

“…However, the pediatric microsurgical literature supports the use of locoregional blockades not only for postoperative analgesia but to optimize arterial flow in upper extremity reconstruction (Level III Evidence). 45,46 These techniques carry a risk of significant morbidity, including permanent neurologic deficit, and the anesthesia literature supports the use of ultrasound (Level I Evidence) by an experienced anesthetist. 47,48 Such a multimodal approach can also be beneficial in terms of avoiding neurotoxicity in the postoperative period.…”

Comparison of post operative analgesia supraclavicular brachial plexus block in children 5 to 10 years of age

“…Various authors till now have done various researches on paediatric brachial plexeus blocks Inberg P et al gave blocks for microvascular surgery in children. Jose Maria B et al did a a preliminary study on vertical infraclavicular brachial plexus block in children [7][8][9][10]. Cheng GL et al used blocks for digital replantation in children [11].…”