Using of spinal-epidural block for multicomponent anesthesias in infants with surgical pathology

Authors

  • M. Yu. Kurochkin

DOI:

https://doi.org/10.14739/2310-1237.2013.1.15360

Keywords:

spinal-epidural anesthesia, infants, surgical pathology, ataralgesia

Abstract

Introduction. In Ukrainian and foreign literature there are publications about usage of central neuroaxial blocks (spinal or caudal) to improve the quality of anesthesia in infants. However, these techniques are used separately in this group of patients as the components of anesthesia and have some imperfections: on the one hand it is the rapid onset of spinal block and a relatively short period of its effect (1.5-2 hours), on the other hand it is slower onset of epidural block, and its  more prolonged effect (4-5 hours).One can avoid these imperfections with the help of combined spinal-epidural applications of local anesthetics.

Objective. The aim of this investigation was to improve the quality of anesthetic management in infants by optimization of the anesthesia techniques.

Materials and Methods. Investigations of central hemodynamics and cortisol levels in the blood were performed in 52 infants operated on for abdominal pathology (congenital disorder of the intestine, Hirschsprung's disease, intussusception), and anomalies of the urinary system (hydronephrosis). The first group consisted of 13 children who received combined endotracheal anesthesia with the use of spinal-epidural block; the 2nd group (control) included 39 ataralgesia subjected children. Blood sampling were carried out in three phases - before making the incision, during operation and after it. Method of anesthesia in infants of the first group differed from the method of control group in the following way: after initial narcosis and using ALV 0.5% solution of bupivacaine in the dosage of 2 mg/kg was injected into the epidural space through the sacral canal. Total volume was 1.2 ml/kg. After that 0.5% solution of bupivacaine was injected into the spinal canal in dosage of 0.3-0.4 mg/kg. The skin incision was performed 5 minutes after endolumbar introduction of bupivacaine. Hemodynamics was studied by impedance rheoplethysmography, cortisol level was determined by enzyme immunoassay. Statistical analysis was performed by the software package (Statistica for Windows).

Results and discussion.

Infants of the first group had the stable hemodynamics and blood pressure, heart rate during operations, also cortisol levels were not significantly changed. Infants of the control group showed increase of blood pressure for 12% and increase of cortisol level in the blood for 50% as compared with initial values.

Conclusions.

1. The use of spinal-epidural block for large abdominal and urologic operations in infants can shorten the time of analgesia onset to 5 minutes and lessen the amount of administered opiates by 5-7 times.

2. Balanced anesthesia with the use of spinal-epidural block in infants has more pronounced anti-stress effect than ataralgesia under stable hemodynamics and blood saturation parameters.

References

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How to Cite

1.
Kurochkin MY. Using of spinal-epidural block for multicomponent anesthesias in infants with surgical pathology. Pathologia [Internet]. 2013Jun.21 [cited 2024Dec.19];(1). Available from: http://pat.zsmu.edu.ua/article/view/15360

Issue

No. 1 (2013)

Section

Original research

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