Caudal analgesia reduces the sevoflurane requirement for LMA removal in anesthetized children

Kim, Joon-Sik; Park, Wyun Kon; Lee, Min-Huiy; Hwang, Kyu-Hyun; Kim, Hee‐Soo; Lee, Jeong Rim

doi:10.4097/kjae.2010.58.6.527

Cited by 8 publications

(12 citation statements)

References 19 publications

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“…; Kim et al. ), which could be a better explanation for the mechanism of temporary CNS signs related to the brain in the present study. Thoracic epidural lidocaine could be delivered to the brain via three potential pathways, including excessive cranial spreading in the epidural space, systemic circulation by vascular absorption (Lemke ), cranial diffusion via CSF in the subarachnoid space (Hodgson & Liu ; Xiao et al.…”

Section: Discussionsupporting

confidence: 57%

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The volume effect of lidocaine on thoracic epidural anesthesia in conscious Beagle dogs

Son

Jang

et al. 2015

Veterinary Anaesthesia and Analgesia

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Section: Discussionsupporting

confidence: 57%

“…; Kim et al. ), or their combinations. However, the effect of epidural and systemic pathways were thought to be minor in our study, because the cranial border of the EB and SB did not reach the brain in the maps, and there was no behavior change after IV injection of lidocaine at the highest dose (4 mg kg −1 ) of the volumes evaluated.…”

Section: Discussionmentioning

confidence: 99%

The volume effect of lidocaine on thoracic epidural anesthesia in conscious Beagle dogs

Son

Jang

et al. 2015

Veterinary Anaesthesia and Analgesia

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“…[ 2 ] Reduction of intraoperative maintenance requirement of inhalation anesthetic like sevoflurane by caudal blockade has been well-established. [ 3 4 5 6 7 8 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 ] Numerous studies have shown this in cases, where volatile anesthetic namely Sevoflurane has been used for maintenance of intra-operative depth. [ 3 4 ]…”

Section: Introductionmentioning

confidence: 99%

A study of the effect of caudal epidural block on bispectral index targeted propofol requirement in children: A comparative study

Banerjee

Das

Mukherjee

et al. 2015

J Indian Assoc Pediatr Surg

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Caudal epidural block is one of the most commonly performed neuraxial block techniques with reliable peri-operative and post-operative analgesia in pediatric patients. In our randomized, prospective, double-blinded, open level, parallel group study, we have established the effect of caudal epidural block on maintenance requirement of intravenous (IV) propofol in targeted bispectral (BIS) monitored patients.Context:Neuraxial anesthesia exhibits sedative properties that may reduce the requirement for general anesthesia. TIVA with propofol has been administered as an established method of maintaining general anesthesia in children. Caudal analgesia being a type of neuraxial block, also seems to reduce the requirement of sedative hypnotics in pediatric patients. Numerous studies show that for patients, administered with caudal epidural block, they require reduced intra-operative volatile inhalation anesthetics. In the present study, we have established the anesthetic sparing effect of Caudal Epidural Analgesia in children undergoing infra-umbilical surgical procedure and calculated the efficacy of propofol-infusion in maintaining adequate depth of anesthesia.Aims:(1) To study and compare the dose requirements of propofol using caudal epidural analgesia. (2) To calculate the efficacy of propofol as maintenance anesthetic agent in both groups and to compare hemodynamic stability of patients in both the techniques.Settings and Design:In our study, after administering general anesthesia to pediatric patients, we have administered caudal analgesia and IV analgesia to monitor the requirement of intra-operative propofol infusion using BIS monitor with a target value of 40-60 in both groups.Materials and Methods:82 patients (aged between 3 and 6 years) have been selected undergoing infra-umbilical surgery and randomly allocated into two groups containing 41 patients in each group. Both the groups group B and group A then intubated with glycopyrrolate, 2 mg/kg injection fentanyl, propofol till loss of verbal contact and atracurium at the rate of 0.5 mg/kg and group B has been administered caudal epidural blockade with 1 ml/kg 0.2% ropivacaine. Propofol infusion at the rate of 10 mg/kg/h is given as maintenance. BIS value has been recorded throughout and propofol requirement at the end of surgery has been calculated.Statistical Analysis Used:Numerical variables between groups have been analyzed using the Student's t-test and the Mann-Whitney U-test as applicable. Categorical variables have been analyzed using the Pearson's Chi-square test. P < 0.05 is considered statistically significant.Results:Consumption of propofol at the start of operation in the group A is 2.9 ± 0.17 and group B is 2.91 ± 0.17, which is not statistically significant (P > 0.05), whereas at the end of the operation in the group A is 11.33 ± 0.17 and group B is 7.83 ± 0.63, which is statistically significant (P < 0.05). Incidence of adverse effects is statistically insignificant between the two groups. The time for administration of rescue analgesic is 2.1 ...

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“…have demonstrated that caudal analgesia reduces the sevoflurane concentration required for the LMA removal. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

Minimum alveolar concentration of desflurane for maintaining BIS below 50 in children and effect of caudal analgesia on it

et al. 2018

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Context:Neuraxial techniques have sedative properties secondary to decreased inputs from sensory and motor afferents. We hypothesized that caudal analgesia decreases the requirement of desflurane as measured by bispectral index (BIS).Aims:This study aims to determine the minimum alveolar concentration (MAC) of desflurane for maintaining BIS below 50 (MACBIS50) in children undergoing infraumbilical surgeries with laryngeal mask airway (LMA) and study the effect of caudal analgesia on the same.Settings and Design:This is prospective and observational study.Subjects and Methods:Thirty-nine American Society of Anesthesiologists physical status Classes I and II children in between 1 and 8 years of age undergoing elective infraumbilical surgery under general anesthesia were allocated randomly into two groups (Group C and Group D) after induction with sevoflurane and LMA insertion. In Group C, caudal block was performed with 0.75 mL/kg of 0.25% bupivacaine and BIS values were recorded after 10 min for 1 min at 10 s intervals. In Group D, BIS was recorded for desflurane for 1 min at 10 s intervals followed by a caudal block with the same dose.Statistical Analysis Used:Dixon up-down method with a step size of 0.5%, and probit analysis were used for analysis.Results:A total of 39 patients were enrolled. MAC of desflurane for maintaining MACBIS50 was 5.57 (95% confidence interval [CI] 5.22–5.95) in Group D and 4.31 (95% CI 3.12–5.08) in Group C. The use of caudal anesthesia lowered the MAC of desflurane for maintaining MACBIS50 in children by 22.36% (P < 0.001).Conclusions:The use of caudal analgesia significantly reduced MAC of desflurane for maintaining MACBIS50 in children undergoing infraumbilical surgeries using LMA.

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Caudal analgesia reduces the sevoflurane requirement for LMA removal in anesthetized children

Cited by 8 publications

References 19 publications

The volume effect of lidocaine on thoracic epidural anesthesia in conscious Beagle dogs

The volume effect of lidocaine on thoracic epidural anesthesia in conscious Beagle dogs

A study of the effect of caudal epidural block on bispectral index targeted propofol requirement in children: A comparative study

Minimum alveolar concentration of desflurane for maintaining BIS below 50 in children and effect of caudal analgesia on it

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