The Use of Epinephrine in Caudal Anesthesia Increases Stroke Volume and Cardiac Output in Children

Liu, Chang Amber; Sui, Jinghu; Coté, Charles J.; Anderson, Thomas A.

doi:10.1097/aap.0000000000000498

Cited by 5 publications

(5 citation statements)

References 36 publications

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“…Our study showed no significant difference in systolic, diastolic, and mean arterial blood pressure between the two groups. However, in our study, children receiving (2). This finding is consistent with our study showing an increase in the first-minute heart rate among children in the study group compared to the control group.…”

Section: Discussionsupporting

confidence: 93%

“…They did not observe any significant difference in the cardiac index and stroke volume between the epinephrine-receiving group and the control group, which is consistent with our study results in changes in heart rate and blood pressure. However, in children aged six months or more, the cardiac index and stroke volume significantly increased in the epinephrinereceiving group compared to the control group (2).…”

Section: Discussionmentioning

confidence: 75%

“…Adding epinephrine to local anesthetics in the caudal block is one of the common methods; however, hemodynamic changes and cardiovascular parameters induced by epinephrine in this method have not been studied well. Epinephrine can prolong the duration of caudal block and can act as an indicator to avoid intravascular injection (2).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cardiovascular Effects of Adding Epinephrine to Bupivacaine in Children Undergoing Caudal Block: A Double-blind Randomized Clinical Trial

Seyedhejazi

Karami

2022

Interv Pain Med Neuromod

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Background: Caudal block is a common, safe, and effective anesthetic technique for lower abdominal, urological, and lower extremity surgeries in pediatrics. Objectives: This study aimed to evaluate the cardiovascular effects of adjuvant epinephrine in the caudal block on heart rate and blood pressure changes in children. Methods: This double-blind, randomized clinical trial was performed on 60 children who underwent elective infra-umbilical surgeries. They were under general anesthesia with midazolam, fentanyl, lidocaine, and propofol. The patients were ventilated through laryngeal mask airway (LMA), and anesthesia was maintained with sevoflurane in O2 and N2O mixture. The intervention group received a caudal block with 0.2% bupivacaine and 1/200000 epinephrine (1 mL/kg), while the control group received a caudal block without epinephrine. Heart rate, blood pressure, and ECG were monitored before the block and in the first, fifth, and 20th minutes after surgery. Results: The two groups showed no statistically significant differences in demographics and systolic and diastolic blood pressures. However, sinus arrhythmia was more prevalent in the study group in the first minute after the block (P < 0.001). No differences were observed in the incidence of arrhythmia in the fifth and 20th minutes after the block. Conclusions: It appears that epinephrine as an adjuvant to the caudal block does not have long-lasting effects after the block, except sinus tachycardia in the first minute. Considering that no changes in blood pressure and other hemodynamic parameters were observed, it seems that epinephrine can be used safely in the caudal block in pediatric patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 75%

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Cardiovascular Effects of Adding Epinephrine to Bupivacaine in Children Undergoing Caudal Block: A Double-blind Randomized Clinical Trial

Seyedhejazi

Karami

2022

Interv Pain Med Neuromod

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“…However, B Cook ( 53 ) demonstrates that its analgesic effect is less pronounced than the addition of ketamine 0.5 mg/kg or clonidine 2 ug/kg to 0.25% bupivacaine on children undergoing inguinal hernia repair and circumcision. Liu's study ( 54 ) is the first to examine the effect of local anesthetic with and without epinephrine in caudal anesthesia using a noninvasive continuous cardiac output (CO) monitor in pediatric patients after the administration of a caudal block while under general anesthesia. Epinephrine added to the local anesthetic injected for caudal anesthesia produces significant increases in stroke volume (SV), cardiac index (CI), and CO in children.…”

Section: Adjuvantsmentioning

confidence: 99%

Methods of prolonging the effect of caudal block in children

Xu,

Wei,

Zhang

2024

Front. Pediatr.

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Caudal epidural blockade is one of the most frequently administered regional anesthesia techniques in children. It is a supplement during general anesthesia and for providing postoperative analgesia in pediatrics for sub-umbilical surgeries, especially for genitourinary surgeries. However, the duration of the analgesic effect is occasionally unsatisfactory. In this review, we discuss the main advantages and disadvantages of different techniques to prolong postoperative analgesia for single-injection caudal blockade in children. A literature search of the keywords “caudal”, “analgesia”, “pediatric”, and “children” was performed using PubMed and Web of Science databases. We highlight that analgesic quality correlates substantially with the local anesthetic's type, dose, the timing relationship between caudal block and surgery, caudal catheterization, and administration of epidural opioids or other adjuvant drugs.

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“…Both methods could provide accurate data about intravascular fluid status for mechanically ventilated patients using FTc (Flow Time Corrected) of TED and SVV (Stroke Volume Variation) of EC. Moreover, Liu et al [17] reported their experience in monitoring cardiac output with EC for patients having regional caudal anaesthesia and their response of COP changes to epinephrine. They demonstrated the clinical benefit of noninvasive EC monitoring of COP in rapid detection of COP change and response to medical intervention.…”

Section: Fig 1 Consort Flow Diagram Of the Participantsmentioning

confidence: 99%

The Effect of Cardiometry Guided Fluid Management on Outcome of Patients Presented for Intracranial Surgeries: Randomized Controlled Study

El-Sheikh

Ismael

Elshmaa

et al. 2021

JAMMR

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Background: Fluid management in neurosurgical patients is critical and important during the perioperative period. Electrical cardiometry (EC) is a new noninvasive technique for measuring cardiac output (COP). EC works based on the application of a high frequency transthoracic current and the analysis of variations of voltage in each heartbeat. The aim of this work is to compare the fluid management of intracranial surgeries using EC routine parameters. Methods: This is a prospective randomized, double-blinded controlled study was carried out on 70 patients of both genders aged > 21 years old, ASA physical status II or III, GCS 15 scheduled for elective craniotomy. Patients were divided into two equal groups at random; group A: standard management, group B: EC guided management. The primary outcome was the duration of intensive care unit (ICU) stay. Results: The ICU and hospital stay duration were significantly decreased in group B compared to group A. The mean total amount of infused volume of crystalloid solutions was significantly decreased in group B compared to group A. Hemodynamics, and number of patients received colloid, blood, vasopressor, and inotropes were insignificantly different between both groups. There was a significant increase in optic nerve sheath diameter in group A compared to group B at PACU and 24 h. Adverse events were comparable between both groups except encephalodema, which was significantly higher in group A. Conclusions: EC is an effective tool in COP measurement and a novel guide for fluid therapy as EC guided fluid therapy group was significantly decreased in ICU and hospital stay duration and the total amount of crystalloid with fewer adverse events.

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The Use of Epinephrine in Caudal Anesthesia Increases Stroke Volume and Cardiac Output in Children

Abstract: Epinephrine added to local anesthetic injected for caudal anesthesia produces significant increases in SV, CO, and CI in children. Stroke volume and CI changes from epinephrine added to local anesthetic for caudal anesthesia seem to take place only in children 6 months or older.

Cited by 5 publications

References 36 publications

Cardiovascular Effects of Adding Epinephrine to Bupivacaine in Children Undergoing Caudal Block: A Double-blind Randomized Clinical Trial

Cardiovascular Effects of Adding Epinephrine to Bupivacaine in Children Undergoing Caudal Block: A Double-blind Randomized Clinical Trial

Methods of prolonging the effect of caudal block in children

The Effect of Cardiometry Guided Fluid Management on Outcome of Patients Presented for Intracranial Surgeries: Randomized Controlled Study

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