Combined spinal – epidural anesthesia in major abdominal surgery in high‐risk neonates and infants

Somri, Mostafa; Tome, Riad; Yanovski, Boris; Asfandiarov, Eldar; Carmi, Nurit; Mogilner, Joerge; David, Bader; Gaitini, Luis

doi:10.1111/j.1460-9592.2007.02278.x

Cited by 40 publications

(31 citation statements)

References 23 publications

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“…2018;9(2):64-67 to potential anesthetic neurotoxicity. Although the use of continuous SA, continuous caudal anesthesia, and SA combined with epidural anesthesia have been previously described ( Table 1, [5][6][7][8][9]), the majority of these reports have used the technique for avoidance of GA in a high-risk child [5][6][7][8][9][10]. Our goal with the reported technique (SA plus placement of a caudal epidural catheter) was to develop a technique that could be offered as a viable alternative to GA for longer surgical procedures, especially given recent concerns of the potential long term neurocognitive effects of general anesthetic agents.…”

Section: Discussionmentioning

confidence: 99%

Combined Spinal and Caudal Epidural Anesthesia for Prolonged Surgical Procedures in Pediatric-Aged Patients: A Report of Two Cases

Geyer¹,

Martin²,

Bhalla³

et al. 2018

J Med Cases

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With emerging evidence that specific anesthetic agents may affect neurocognitive outcomes, there has been renewed interest in the applications of spinal anesthesia in neonates and infants. Because of its short duration of action, spinal anesthesia in infants is generally limited to procedures lasting less than 70 -75 min. To avoid this limitation, we report a technique combining spinal and caudal epidural anesthesia. We present two infants in whom this technique was used to provide surgical anesthesia (without general anesthesia or airway manipulation) for two cases lasting more than 90 min. The technique used is presented, its applications discussed, and previous reports reviewed.

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Section: Discussionmentioning

confidence: 99%

Combined Spinal and Caudal Epidural Anesthesia for Prolonged Surgical Procedures in Pediatric-Aged Patients: A Report of Two Cases

Geyer¹,

Martin²,

Bhalla³

et al. 2018

J Med Cases

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“…Recent reports on the efficacy and safety of combined spinal-epidural anaesthesia (CSEA) in major abdominal surgery showed good results when patients were managed by paediatric anaesthetists. Spinal anaesthesia has a rapid onset, creating comfortable conditions for the performance of epidural anaesthesia, in which the epidural allows the continuation of surgical anaesthesia as well as extended postoperative analgesia [69,70]. CSEA as well as thoracic epidural blockade can be used to avoid prolonged mechanical ventilation and its associated morbidity via improved diaphragmatic contractility, especially in high-risk premature infants [71].…”

Section: Anaesthetic Techniquementioning

confidence: 99%

Improved outcomes in paediatric anaesthesia: contributing factors

Somri

Coran

Hadjittofi³

et al. 2012

Pediatr Surg Int

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Despite substantial progress, there is still much room for improvement in areas such as adverse-event reporting, anaesthetic-related risk and late neurocognitive outcomes. Systematic reviews comparing paediatric patient outcomes after neuroaxial block versus general anaesthesia are currently unavailable. The future of paediatric anaesthesia will most likely be influenced by much-needed large prospective studies, which can provide further insight into patient safety and service delivery.

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“…Ortopedik cerrahide hem intraoperatif hem de erken postoperatif ağrı çocuklar için önemli bir sorundur. Santral nöroaksiyal bloklar çoğu zaman tercih edilebilseler de kontrendikasyonları ve yan etkileri nedeniyle her zaman uygulamak mümkün değildir (5). Opioid tedavisi de postoperatif dönemde bulantı, kusma, kaşıntı gibi yan etkilere neden olabilir (6).…”

Section: Introductionunclassified

Ultrasound-guided regional anesthesia for orthopedic surgery in pediatric patients

Şahin¹,

Şahin²,

Aktas³

et al. 2011

Gaziantep Med J

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ÖzetUltrasonun (US) kullanıma girmesi pediatrik rejyonal anestezide çok önemli gelişmelere yol açmış ve US kılavuzluğu ile zor rejyonal uygulamalar dahi çocuklarda yapılabilir hale gelmiştir. Biz bu çalışmada kliniğimizde ortopedi ameliyat salonunda son 1 yılda opere edilen yaşları 1 ile 16 arasında değişen 81 pediatrik olguya intraoperatif anestezi, analjezi veya postoperatif analjezi amacıyla yaptığımız US kılavuzluğunda periferik sinir ve pleksus bloklarını literatür bilgileri ışığında tartışmayı amaçladık. Bu çalışma için hastaların anestezi formları, rejyonal anestezi değerlendirme formları, hemşire gözlem formları ve hastane çıkış epikrizleri kullanıldı. Hastaların bireysel özellikleri (yaş, cinsiyet, vücut ağırlığı, boy), ASA skorları, anestezi özellikleri, postoperatif analjezi ve motor blok süreleri, ve komplikasyonlar kaydedildi. Hastaların ortalama analjezi süresi üst ekstremite ve alt ekstremite için sırasıyla 5.8 ± 1.6 saat ve 8.7 ± 2.5 saat, motor blok süresi üst ekstremite ve alt ekstremite için sırasıyla 3.6 ± 0.7 saat ve 5.3 ± 1.8 saat olarak bulundu. Üç hastada başarısız veya yetersiz blok mevcuttu. Ortopedik cerrahi uygulanan pediatrik hastalarda rejyonal bloklar US-kılavuzluğunda etkin ve güvenli bir şekilde uygulanabilir ve yüksek başarı, minimal komplikasyon oranına sahiptir. Anahtar kelimeler: Ortopedik cerrahi; pediatrik; rejyonal anestezi; ultrason Abstract Introduction of the use of ultrasound (US) has led to very important developments in pediatric regional anesthesia and made applications, which are hard or even impossible to perform, applicable by the guidance of US. In this study, we aimed to discuss USguided peripheral nerve and plexus blocks that we made for intraoperative anesthesia, analgesia or postoperative analgesia in 81 pediatric patients ranging from ages 1 to 16 who were operated in the last year. For this study, anesthesia forms, evaluation forms of regional anesthesia, observation forms for nurses, and hospital epicrises of patients were used. Demographic data (age, sex, weigh, height), ASA scores, anesthetic properties, postoperative duration of analgesia and motor block and complications of patients were recorded. Estimated mean duration of analgesia for upper and lower extremities were 5.8 ± 1.6 h, and 8.7 ± 2.5 h, respectively, the duration of motor block for upper and lower extremities were 3.6 ± 0.7 h, 5.3 ± 1.8 h, respectively. Failed or insufficient block count was three. In orthopedic surgery applied pediatric patients US-guided regional blocks can be applied effectively and safely and it has high achievement and minimal complication rates.

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Combined spinal – epidural anesthesia in major abdominal surgery in high‐risk neonates and infants

Cited by 40 publications

References 23 publications

Combined Spinal and Caudal Epidural Anesthesia for Prolonged Surgical Procedures in Pediatric-Aged Patients: A Report of Two Cases

Combined Spinal and Caudal Epidural Anesthesia for Prolonged Surgical Procedures in Pediatric-Aged Patients: A Report of Two Cases

Improved outcomes in paediatric anaesthesia: contributing factors

Ultrasound-guided regional anesthesia for orthopedic surgery in pediatric patients

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