Paediatric caudal anaesthesia - Revision history

WikiSysop: /* Test dose */

2021-10-30T17:52:00Z

Test dose

← Older revision		Revision as of 17:52, 30 October 2021
Line 63:		Line 63:

	=== Test dose ===		=== Test dose ===
	Early neurosensory warning symptoms of LA systemic toxicity are concealed by general anaesthesia. Halogenated anaesthetic agents worsen LA systemic toxicity and can also blunt the cardiovascular signs of an intravenous epinephrine test dose injection. Aspiration tests to elicit blood reflux are not very sensitive, particularly in infants. A test dose of epinephrine 0.5mcg.kg-1 (administered as 0.1ml.kg-1 lidocaine with epinephrine 1 in 200 000) allows detection of intravenous injection with sensitivity and specificity close to 100%, under halogenated anaesthesia. [[File:Caudal Positive test ECG.jpg\|thumb\|'''Figure 9.''' T-wave amplitude change after intravascular injection of a local anaesthetic agent]] Warning symptoms are cardiac frequency modification (an increase or decrease by 10 beats per minute), increased in blood pressure (up to 15mmHg), or T-wave amplitude change in the 60 to 90 second period after injection (Figure 9). <ref name=":1">Kozek-Langenecker SA, Marhofer P, Jonas K, Macik T, Urak G, Semsroth M. Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children. Anesth Analg 2000; 90: 579-83.</ref>, <ref>Tobias JD. Caudal epidural block: a review of test dosing and recognition injection in children. Anesth Analg 2001; 93: 1156-61.</ref> Slow injection of the whole LA dose under haemodynamic and ECG monitoring remains essential for patient safety.		Early neurosensory warning symptoms of LA systemic toxicity are concealed by general anaesthesia. Halogenated anaesthetic agents worsen LA systemic toxicity and can also blunt the cardiovascular signs of an intravenous epinephrine test dose injection. Aspiration tests to elicit blood reflux are not very sensitive, particularly in infants. A test dose of epinephrine 0.5mcg.kg-1 (administered as 0.1ml.kg-1 lidocaine with epinephrine 1 in 200 000) allows detection of intravenous injection with sensitivity and specificity close to 100%, under halogenated anaesthesia. [[File:Caudal Positive test ECG.jpg\|thumb\|'''Figure 9.''' T-wave amplitude change after intravascular injection of a local anaesthetic agent\|alt=\|center]] Warning symptoms are cardiac frequency modification (an increase or decrease by 10 beats per minute), increased in blood pressure (up to 15mmHg), or T-wave amplitude change in the 60 to 90 second period after injection (Figure 9). <ref name=":1">Kozek-Langenecker SA, Marhofer P, Jonas K, Macik T, Urak G, Semsroth M. Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children. Anesth Analg 2000; 90: 579-83.</ref>, <ref>Tobias JD. Caudal epidural block: a review of test dosing and recognition injection in children. Anesth Analg 2001; 93: 1156-61.</ref> Slow injection of the whole LA dose under haemodynamic and ECG monitoring remains essential for patient safety.

	=== Full dose ===		=== Full dose ===

WikiSysop: /* Test dose */

2021-10-30T17:51:13Z

Test dose

← Older revision		Revision as of 17:51, 30 October 2021
Line 63:		Line 63:

	=== Test dose ===		=== Test dose ===
	Early neurosensory warning symptoms of LA systemic toxicity are concealed by general anaesthesia. Halogenated anaesthetic agents worsen LA systemic toxicity and can also blunt the cardiovascular signs of an intravenous epinephrine test dose injection. Aspiration tests to elicit blood reflux are not very sensitive, particularly in infants. A test dose of epinephrine 0.5mcg.kg-1 (administered as 0.1ml.kg-1 lidocaine with epinephrine 1 in 200 000) allows detection of intravenous injection with sensitivity and specificity close to 100%, under halogenated anaesthesia. Warning symptoms are cardiac frequency modification (an increase or decrease by 10 beats per minute), increased in blood pressure (up to 15mmHg), or T-wave amplitude change in the 60 to 90 second period after injection (Figure 9). <ref name=":1">Kozek-Langenecker SA, Marhofer P, Jonas K, Macik T, Urak G, Semsroth M. Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children. Anesth Analg 2000; 90: 579-83.</ref>, <ref>Tobias JD. Caudal epidural block: a review of test dosing and recognition injection in children. Anesth Analg 2001; 93: 1156-61.</ref> Slow injection of the whole LA dose under haemodynamic and ECG monitoring remains essential for patient safety.		Early neurosensory warning symptoms of LA systemic toxicity are concealed by general anaesthesia. Halogenated anaesthetic agents worsen LA systemic toxicity and can also blunt the cardiovascular signs of an intravenous epinephrine test dose injection. Aspiration tests to elicit blood reflux are not very sensitive, particularly in infants. A test dose of epinephrine 0.5mcg.kg-1 (administered as 0.1ml.kg-1 lidocaine with epinephrine 1 in 200 000) allows detection of intravenous injection with sensitivity and specificity close to 100%, under halogenated anaesthesia. [[File:Caudal Positive test ECG.jpg\|thumb\|'''Figure 9.''' T-wave amplitude change after intravascular injection of a local anaesthetic agent]] Warning symptoms are cardiac frequency modification (an increase or decrease by 10 beats per minute), increased in blood pressure (up to 15mmHg), or T-wave amplitude change in the 60 to 90 second period after injection (Figure 9). <ref name=":1">Kozek-Langenecker SA, Marhofer P, Jonas K, Macik T, Urak G, Semsroth M. Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children. Anesth Analg 2000; 90: 579-83.</ref>, <ref>Tobias JD. Caudal epidural block: a review of test dosing and recognition injection in children. Anesth Analg 2001; 93: 1156-61.</ref> Slow injection of the whole LA dose under haemodynamic and ECG monitoring remains essential for patient safety.

	=== Full dose ===		=== Full dose ===

WikiSysop: /* Full dose */

2021-10-30T17:50:27Z

Full dose

← Older revision		Revision as of 17:50, 30 October 2021
Line 65:		Line 65:
	Early neurosensory warning symptoms of LA systemic toxicity are concealed by general anaesthesia. Halogenated anaesthetic agents worsen LA systemic toxicity and can also blunt the cardiovascular signs of an intravenous epinephrine test dose injection. Aspiration tests to elicit blood reflux are not very sensitive, particularly in infants. A test dose of epinephrine 0.5mcg.kg-1 (administered as 0.1ml.kg-1 lidocaine with epinephrine 1 in 200 000) allows detection of intravenous injection with sensitivity and specificity close to 100%, under halogenated anaesthesia. Warning symptoms are cardiac frequency modification (an increase or decrease by 10 beats per minute), increased in blood pressure (up to 15mmHg), or T-wave amplitude change in the 60 to 90 second period after injection (Figure 9). <ref name=":1">Kozek-Langenecker SA, Marhofer P, Jonas K, Macik T, Urak G, Semsroth M. Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children. Anesth Analg 2000; 90: 579-83.</ref>, <ref>Tobias JD. Caudal epidural block: a review of test dosing and recognition injection in children. Anesth Analg 2001; 93: 1156-61.</ref> Slow injection of the whole LA dose under haemodynamic and ECG monitoring remains essential for patient safety.		Early neurosensory warning symptoms of LA systemic toxicity are concealed by general anaesthesia. Halogenated anaesthetic agents worsen LA systemic toxicity and can also blunt the cardiovascular signs of an intravenous epinephrine test dose injection. Aspiration tests to elicit blood reflux are not very sensitive, particularly in infants. A test dose of epinephrine 0.5mcg.kg-1 (administered as 0.1ml.kg-1 lidocaine with epinephrine 1 in 200 000) allows detection of intravenous injection with sensitivity and specificity close to 100%, under halogenated anaesthesia. Warning symptoms are cardiac frequency modification (an increase or decrease by 10 beats per minute), increased in blood pressure (up to 15mmHg), or T-wave amplitude change in the 60 to 90 second period after injection (Figure 9). <ref name=":1">Kozek-Langenecker SA, Marhofer P, Jonas K, Macik T, Urak G, Semsroth M. Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children. Anesth Analg 2000; 90: 579-83.</ref>, <ref>Tobias JD. Caudal epidural block: a review of test dosing and recognition injection in children. Anesth Analg 2001; 93: 1156-61.</ref> Slow injection of the whole LA dose under haemodynamic and ECG monitoring remains essential for patient safety.
	=== Full dose ===		=== Full dose ===
	~~[[File:Caudal Positive test ECG.jpg\|thumb\|'''Figure 9.''' T-wave amplitude change after intravascular injection of a local anaesthetic agent]]~~
	The volume of caudally injected LA determines the spread of the block and this must be adapted to surgical procedure (Table 1). Analgesic spread will be two dermatomes higher on the down positioned side at the time of puncture. Injected volume must not exceed 1.25 ml.kg-1 or 20 to 25ml, in order to avoid excessive cerebrospinal fluid pressure.		The volume of caudally injected LA determines the spread of the block and this must be adapted to surgical procedure (Table 1). Analgesic spread will be two dermatomes higher on the down positioned side at the time of puncture. Injected volume must not exceed 1.25 ml.kg-1 or 20 to 25ml, in order to avoid excessive cerebrospinal fluid pressure.

WikiSysop: /* Full dose */

2021-10-30T17:49:46Z

Full dose

← Older revision		Revision as of 17:49, 30 October 2021
Line 63:		Line 63:

	=== Test dose ===		=== Test dose ===
	Early neurosensory warning symptoms of LA systemic toxicity are concealed by general anaesthesia. Halogenated anaesthetic agents worsen LA systemic toxicity and can also blunt the cardiovascular signs of an intravenous epinephrine test dose injection. Aspiration tests to elicit blood reflux are not very sensitive, particularly in infants. A test dose of epinephrine 0.5mcg.kg-1 (administered as 0.1ml.kg-1 lidocaine with epinephrine 1 in 200 000) allows detection of intravenous injection with sensitivity and specificity close to 100%, under halogenated anaesthesia. Warning symptoms are cardiac frequency modification (an increase or decrease by 10 beats per minute), increased in blood pressure (up to 15mmHg), or T-wave amplitude change in the 60 to 90 second period after injection (Figure 9). <ref name=":1">Kozek-Langenecker SA, Marhofer P, Jonas K, Macik T, Urak G, Semsroth M. Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children. Anesth Analg 2000; 90: 579-83.</ref>, <ref>Tobias JD. Caudal epidural block: a review of test dosing and recognition injection in children. Anesth Analg 2001; 93: 1156-61.</ref> Slow injection of the whole LA dose under haemodynamic and ECG monitoring remains essential for patient safety.~~[[File:Caudal Positive test ECG.jpg\|thumb\|'''Figure 9.''' T-wave amplitude change after intravascular injection of a local anaesthetic agent]]~~		Early neurosensory warning symptoms of LA systemic toxicity are concealed by general anaesthesia. Halogenated anaesthetic agents worsen LA systemic toxicity and can also blunt the cardiovascular signs of an intravenous epinephrine test dose injection. Aspiration tests to elicit blood reflux are not very sensitive, particularly in infants. A test dose of epinephrine 0.5mcg.kg-1 (administered as 0.1ml.kg-1 lidocaine with epinephrine 1 in 200 000) allows detection of intravenous injection with sensitivity and specificity close to 100%, under halogenated anaesthesia. Warning symptoms are cardiac frequency modification (an increase or decrease by 10 beats per minute), increased in blood pressure (up to 15mmHg), or T-wave amplitude change in the 60 to 90 second period after injection (Figure 9). <ref name=":1">Kozek-Langenecker SA, Marhofer P, Jonas K, Macik T, Urak G, Semsroth M. Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children. Anesth Analg 2000; 90: 579-83.</ref>, <ref>Tobias JD. Caudal epidural block: a review of test dosing and recognition injection in children. Anesth Analg 2001; 93: 1156-61.</ref> Slow injection of the whole LA dose under haemodynamic and ECG monitoring remains essential for patient safety.
	=== Full dose ===		=== Full dose ===
			[[File:Caudal Positive test ECG.jpg\|thumb\|'''Figure 9.''' T-wave amplitude change after intravascular injection of a local anaesthetic agent]]
	The volume of caudally injected LA determines the spread of the block and this must be adapted to surgical procedure (Table 1). Analgesic spread will be two dermatomes higher on the down positioned side at the time of puncture. Injected volume must not exceed 1.25 ml.kg-1 or 20 to 25ml, in order to avoid excessive cerebrospinal fluid pressure.		The volume of caudally injected LA determines the spread of the block and this must be adapted to surgical procedure (Table 1). Analgesic spread will be two dermatomes higher on the down positioned side at the time of puncture. Injected volume must not exceed 1.25 ml.kg-1 or 20 to 25ml, in order to avoid excessive cerebrospinal fluid pressure.

WikiSysop: /* LOCAL ANAESTHETIC AGENTS */

2021-10-30T17:48:55Z

LOCAL ANAESTHETIC AGENTS

← Older revision		Revision as of 17:48, 30 October 2021
Line 63:		Line 63:

	=== Test dose ===		=== Test dose ===
	~~[[File:Caudal Positive test ECG.jpg\|thumb\|'''Figure 9.''' T-wave amplitude change after intravascular injection of a local anaesthetic agent]]~~		Early neurosensory warning symptoms of LA systemic toxicity are concealed by general anaesthesia. Halogenated anaesthetic agents worsen LA systemic toxicity and can also blunt the cardiovascular signs of an intravenous epinephrine test dose injection. Aspiration tests to elicit blood reflux are not very sensitive, particularly in infants. A test dose of epinephrine 0.5mcg.kg-1 (administered as 0.1ml.kg-1 lidocaine with epinephrine 1 in 200 000) allows detection of intravenous injection with sensitivity and specificity close to 100%, under halogenated anaesthesia. Warning symptoms are cardiac frequency modification (an increase or decrease by 10 beats per minute), increased in blood pressure (up to 15mmHg), or T-wave amplitude change in the 60 to 90 second period after injection (Figure 9). <ref name=":1">Kozek-Langenecker SA, Marhofer P, Jonas K, Macik T, Urak G, Semsroth M. Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children. Anesth Analg 2000; 90: 579-83.</ref>, <ref>Tobias JD. Caudal epidural block: a review of test dosing and recognition injection in children. Anesth Analg 2001; 93: 1156-61.</ref> Slow injection of the whole LA dose under haemodynamic and ECG monitoring remains essential for patient safety.[[File:Caudal Positive test ECG.jpg\|thumb\|'''Figure 9.''' T-wave amplitude change after intravascular injection of a local anaesthetic agent]]
	Early neurosensory warning symptoms of LA systemic toxicity are concealed by general anaesthesia. Halogenated anaesthetic agents worsen LA systemic toxicity and can also blunt the cardiovascular signs of an intravenous epinephrine test dose injection. Aspiration tests to elicit blood reflux are not very sensitive, particularly in infants. A test dose of epinephrine 0.5mcg.kg-1 (administered as 0.1ml.kg-1 lidocaine with epinephrine 1 in 200 000) allows detection of intravenous injection with sensitivity and specificity close to 100%, under halogenated anaesthesia. Warning symptoms are cardiac frequency modification (an increase or decrease by 10 beats per minute), increased in blood pressure (up to 15mmHg), or T-wave amplitude change in the 60 to 90 second period after injection (Figure 9). <ref name=":1">Kozek-Langenecker SA, Marhofer P, Jonas K, Macik T, Urak G, Semsroth M. Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children. Anesth Analg 2000; 90: 579-83.</ref>, <ref>Tobias JD. Caudal epidural block: a review of test dosing and recognition injection in children. Anesth Analg 2001; 93: 1156-61.</ref> Slow injection of the whole LA dose under haemodynamic and ECG monitoring remains essential for patient safety.

	=== Full dose ===		=== Full dose ===
	The volume of caudally injected LA determines the spread of the block and this must be adapted to surgical procedure (Table 1). Analgesic spread will be two dermatomes higher on the down positioned side at the time of puncture. Injected volume must not exceed 1.25 ml.kg-1 or 20 to 25ml, in order to avoid excessive cerebrospinal fluid pressure.		The volume of caudally injected LA determines the spread of the block and this must be adapted to surgical procedure (Table 1). Analgesic spread will be two dermatomes higher on the down positioned side at the time of puncture. Injected volume must not exceed 1.25 ml.kg-1 or 20 to 25ml, in order to avoid excessive cerebrospinal fluid pressure.

WikiSysop at 17:47, 30 October 2021

2021-10-30T17:47:50Z

← Older revision		Revision as of 17:47, 30 October 2021
Line 1:		Line 1:
	[[File:Wfsahq-logo.png\|200px\|thumb\|right]]		[[File:Wfsahq-logo.png\|200px\|thumb\|right]]


	''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''		''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''
Line 44:		Line 43:

	=== Puncture (Figures 3, 4 and 5) ===		=== Puncture (Figures 3, 4 and 5) ===
	[[File:Bony landmarks.jpg\|thumb\|'''Figure 3.''' Bony landmarks]]		[[File:Bony landmarks.jpg\|thumb\|'''Figure 3.''' Bony landmarks\|alt=\|left]]
	After defining the bony landmarks of the sacral triangle, the two sacral cornuae are identified by moving your fingertips from side to side. The gluteal cleft is not a reliable mark of the midline. The puncture is performed between the two sacral cornuae. The needle is oriented 60° in relation to back plane, 90° to skin surface. The needle bevel is oriented ventrally, or parallel to the fibers of the sacro-coccygeal ligament.		After defining the bony landmarks of the sacral triangle, the two sacral cornuae are identified by moving your fingertips from side to side. The gluteal cleft is not a reliable mark of the midline. The puncture is performed between the two sacral cornuae. The needle is oriented 60° in relation to back plane, 90° to skin surface. The needle bevel is oriented ventrally, or parallel to the fibers of the sacro-coccygeal ligament.
	[[File:Puncture - orientation of the needle and reorientation after.jpg\|thumb\|'''Figure 4.''' Puncture - orientation of the needle and reorientation after crossing the sacro-coccygeal ligament]]		[[File:Puncture - orientation of the needle and reorientation after.jpg\|thumb\|'''Figure 4.''' Puncture - orientation of the needle and reorientation after crossing the sacro-coccygeal ligament]]
Line 50:		Line 49:
	The distance between the skin and sacro-coccygeal ligament is between 5 and 15mm, depending on the child’s size. The sacrococcygeal ligament gives a perceptible ‘pop’ when crossed, analogous to the ligamentum flavum during lumbar epidural anaesthesia. After crossing the sacro-coccygeal ligament, the needle is redirected 30° to the skin surface, and then advanced a few millimeters into sacral canal. If in contact with the bony ventral wall of sacral canal, the needle must be moved back slightly.		The distance between the skin and sacro-coccygeal ligament is between 5 and 15mm, depending on the child’s size. The sacrococcygeal ligament gives a perceptible ‘pop’ when crossed, analogous to the ligamentum flavum during lumbar epidural anaesthesia. After crossing the sacro-coccygeal ligament, the needle is redirected 30° to the skin surface, and then advanced a few millimeters into sacral canal. If in contact with the bony ventral wall of sacral canal, the needle must be moved back slightly.

	[[File:Orientation of the needle during puncture.jpg\|thumb\|'''Figure 5'''. Orientation of the needle during puncture]]		[[File:Orientation of the needle during puncture.jpg\|thumb\|'''Figure 5'''. Orientation of the needle during puncture\|alt=\|left]]
	[[File:Needle misplacement.jpg\|thumb\|'''Figure 6A and B.''' Needle misplacement ('''A''' marrow (resistance +++. Equivalent to IV injection), '''B''' posterior sacral ligament (subcutaneous bulge), '''C''' subperiostal, '''D''' “decoy” hiatus, '''E''' intrapelvic (risk of damaging intrapelvic structures: rectum), '''F''' 4th sacral foramen (unilateral block)).]]		[[File:Needle misplacement.jpg\|thumb\|'''Figure 6A and B.''' Needle misplacement ('''A''' marrow (resistance +++. Equivalent to IV injection), '''B''' posterior sacral ligament (subcutaneous bulge), '''C''' subperiostal, '''D''' “decoy” hiatus, '''E''' intrapelvic (risk of damaging intrapelvic structures: rectum), '''F''' 4th sacral foramen (unilateral block)).]]

			After verifying absence of spontaneous reflux of blood or cerebrospinal fluid (more sensitive than an aspiration test), injection of LA should be possible be without resistance. Inject slowly (over about one minute). Where available this may be preceded with an epinephrine test dose under ECG and blood pressure monitoring, in order to detect intravascular placement. Subcutaneous bulging at the injection site suggests needle misplacement. Blood reflux necessitates repeating the puncture, however in case of cerebrospinal fluid reflux caudal anaesthesia should be abandoned, in order to avoid the risk of extensive spinal anaesthesia. Aspiration tests should be repeated several times during injection.[[File:US of sacro-coccygeal space.jpg\|thumb\|'''Figure 7.''' Ultrasound of sacro-coccygeal space]]
	After verifying absence of spontaneous reflux of blood or cerebrospinal fluid (more sensitive than an aspiration test), injection of LA should be possible be without resistance. Inject slowly (over about one minute). Where available this may be preceded with an epinephrine test dose under ECG and blood pressure monitoring, in order to detect intravascular placement. Subcutaneous bulging at the injection site suggests needle misplacement. Blood reflux necessitates repeating the puncture, however in case of cerebrospinal fluid reflux caudal anaesthesia should be abandoned, in order to avoid the risk of extensive spinal anaesthesia. Aspiration tests should be repeated several times during injection.


Line 60:		Line 58:

	=== Catheter insertion ===		=== Catheter insertion ===
	Although CA was initially described as a single shot technique, some authors have described use of a caudal catheter to prolong analgesic administration in postoperative period. In addition advancement of the catheter in the epidural space up to lumbar or even thoracic levels can achieve analgesia of high abdominal or thoracic areas.<ref>Tsui BC, Berde CB. Caudal analgesia and anesthesia techniques in children. Curr Op Anesthesiol 2005; 18: 283-8.</ref> However, two pitfalls restrict extension of this technique; a high risk of catheter bacterial colonization, particularly in infants and a high risk of catheter misplacement.<ref>Kost-Byerly S, Tobin JR, Greenberg RS, Billett C, Zahurak M, Yaster M. Bacterial colonisation and infectious rate of continuous epidural catheters in children. Anesth Analg 1998; 86: 712-6</ref>,<ref>Valairucha S, Seefelder D, Houck CS. Thoracic epidural catheters placed by the caudal route in infants: the importance of radiographic confirmation. Paediatr Anaesth 2002; 12: 424-8.</ref> Subcutaneous tunnelling at a distance from the anal orifice, or occlusive dressings decrease bacterial colonization.<ref>Bubeck J, Boss K, Krause H, Thies KC. Subcutaneous tunneling of caudal catheters reduces the rate of bacterial colonization to that of lumbar epidural catheters. Anesth Analg 2004; 99: 689-93.</ref> Electrical nerve stimulation or ECG recording on the catheter, or its echographic visualization have been suggested to guide its advancement in epidural space.<ref>Tsui BC, Wagner A, Cave D, Kearny R. Thoracic and lumbar epidural analgesia via the caudal approach using electrical stimulation guidance in pediatric patients: a review of 289 patients. Anesthesiology 2004; 100: 683-9.</ref>,<ref>Chawathe MS, Jones RM, Gildersleve CD, Harrison SK, Morris SJ, Eickmann C. Detection of epidural catheters with ultrasound in children. Paediatr Anaesth 2003; 13: 681-4</ref> However, most anaesthetists presently prefer a direct epidural approach at the desired level that is appropriate to the surgical intervention.<ref>Bösenberg AT. Epidural analgesia for major neonatal surgery. Paediatr Anaesth 1998; 8: 479-83.</ref>,<ref>Giaufré E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-language society of pediatric anesthesiologists. Anesth Analg 1996; 83: 904-12</ref>		[[File:US use in caudal block.jpg\|thumb\|'''Figures 8a and 8b.''' Ultrasound use in caudal block\|alt=\|left]]Although CA was initially described as a single shot technique, some authors have described use of a caudal catheter to prolong analgesic administration in postoperative period. In addition advancement of the catheter in the epidural space up to lumbar or even thoracic levels can achieve analgesia of high abdominal or thoracic areas.<ref>Tsui BC, Berde CB. Caudal analgesia and anesthesia techniques in children. Curr Op Anesthesiol 2005; 18: 283-8.</ref> However, two pitfalls restrict extension of this technique; a high risk of catheter bacterial colonization, particularly in infants and a high risk of catheter misplacement.<ref>Kost-Byerly S, Tobin JR, Greenberg RS, Billett C, Zahurak M, Yaster M. Bacterial colonisation and infectious rate of continuous epidural catheters in children. Anesth Analg 1998; 86: 712-6</ref>,<ref>Valairucha S, Seefelder D, Houck CS. Thoracic epidural catheters placed by the caudal route in infants: the importance of radiographic confirmation. Paediatr Anaesth 2002; 12: 424-8.</ref> Subcutaneous tunnelling at a distance from the anal orifice, or occlusive dressings decrease bacterial colonization.<ref>Bubeck J, Boss K, Krause H, Thies KC. Subcutaneous tunneling of caudal catheters reduces the rate of bacterial colonization to that of lumbar epidural catheters. Anesth Analg 2004; 99: 689-93.</ref> Electrical nerve stimulation or ECG recording on the catheter, or its echographic visualization have been suggested to guide its advancement in epidural space.<ref>Tsui BC, Wagner A, Cave D, Kearny R. Thoracic and lumbar epidural analgesia via the caudal approach using electrical stimulation guidance in pediatric patients: a review of 289 patients. Anesthesiology 2004; 100: 683-9.</ref>,<ref>Chawathe MS, Jones RM, Gildersleve CD, Harrison SK, Morris SJ, Eickmann C. Detection of epidural catheters with ultrasound in children. Paediatr Anaesth 2003; 13: 681-4</ref> However, most anaesthetists presently prefer a direct epidural approach at the desired level that is appropriate to the surgical intervention.<ref>Bösenberg AT. Epidural analgesia for major neonatal surgery. Paediatr Anaesth 1998; 8: 479-83.</ref>,<ref>Giaufré E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-language society of pediatric anesthesiologists. Anesth Analg 1996; 83: 904-12</ref>

	~~[[File:US of sacro-coccygeal space.jpg\|thumb\|'''Figure 7.''' Ultrasound of sacro-coccygeal space]]~~
	~~[[File:US use in caudal block.jpg\|thumb\|'''Figures 8a and 8b.''' Ultrasound use in caudal block]]~~

	== LOCAL ANAESTHETIC AGENTS ==		== LOCAL ANAESTHETIC AGENTS ==

WikiSysop at 17:11, 30 October 2021

2021-10-30T17:11:07Z

← Older revision		Revision as of 17:11, 30 October 2021
Line 1:		Line 1:
	[[File:Wfsahq-logo.png\|200px\|thumb\|right]]		[[File:Wfsahq-logo.png\|200px\|thumb\|right]]
	~~This page is under construction, converting the originally formatted pdf from the WFSA site with wiki embellishments.~~

	''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''		''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''

WikiSysop: /* REFERENCES */

2021-10-30T17:08:32Z

REFERENCES

← Older revision		Revision as of 17:08, 30 October 2021
Line 145:		Line 145:

	== REFERENCES ==		== REFERENCES ==
	Raux O, Dadure C, Carr J, Rochette A, Capdevila X. Paediatric caudal anaesthesia. Update in Anaesthesia (2010) 26:32-36. ~~Available from: <nowiki>http://www.wfsahq.org/documents/Update%20in%20Anaesthesia/</nowiki> update%20026%202010.pdf~~		[http://www.wfsahq.org/documents/Update%20in%20Anaesthesia/ update%20026%202010.pdf Raux O, Dadure C, Carr J, Rochette A, Capdevila X. Paediatric caudal anaesthesia. Update in Anaesthesia (2010) 26:32-36].

WikiSysop at 17:07, 30 October 2021

2021-10-30T17:07:33Z

← Older revision		Revision as of 17:07, 30 October 2021
Line 145:		Line 145:

	== REFERENCES ==		== REFERENCES ==
	Raux O, Dadure C, Carr J, Rochette A, Capdevila X. Paediatric caudal anaesthesia. Update in Anaesthesia (2010) 26:32-36. Available from: <nowiki>http://www.wfsahq.org/documents/Update%20in%20Anaesthesia/</nowiki> update%20026%202010.pdf		Raux O, Dadure C, Carr J, Rochette A, Capdevila X. Paediatric caudal anaesthesia. Update in Anaesthesia (2010) 26:32-36. Available from: <nowiki>http://www.wfsahq.org/documents/Update%20in%20Anaesthesia/</nowiki> update%20026%202010.pdf

	~~1. Adewale L, Dearlove O, Wilson B, Hindle K, Robinson DN. The caudal canal in children: a study using magnetic resonance imaging. Paediatr Anaesth 2000; 10: 137-41.~~

	~~2. Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth analg 1989; 68: 83-9.~~

	~~3. Orme RM, Berg SJ. The “swoosh” test - an evaluation of a modified “whoosh” test in children. Br J Anaesth 2003; 90: 62-5.~~

	~~4. Tsui BC, Tarkkila P, Gupta S, Kearney R. Confirmation of caudal needle placement using nerve stimulation. Anesthesiology 1999; 91: 374-8.~~

	~~5. Raghunathan K, Schwartz D, Conelly NR. Determining the accuracy of caudal needle placement in children: a comparison of the swoosh test and ultrasonography. Paediatr Anaesth 2008; 18: 606-12.~~

	~~6. Roberts SA, Guruswamy V, Galvez I. Caudal injectate can be reliably imaged using portable ultrasound - a preliminary result. Paediatr anaesth 2005; 15: 948-52.~~

	~~7. Schwartz DA, Dunn SM, Conelly NR. Ultrasound and caudal blocks in children. Paediatr Anaesth 2006; 16: 892-902 (correspondence).~~

	~~8. Tsui BC, Berde CB. Caudal analgesia and anesthesia techniques in children. Curr Op Anesthesiol 2005; 18: 283-8.~~

	~~9. Kost-Byerly S, Tobin JR, Greenberg RS, Billett C, Zahurak M, Yaster M. Bacterial colonisation and infectious rate of continuous epidural catheters in children. Anesth Analg 1998; 86: 712-6.~~

	~~10. Valairucha S, Seefelder D, Houck CS. Thoracic epidural catheters placed by the caudal route in infants: the importance of radiographic confirmation. Paediatr Anaesth 2002; 12: 424-8.~~

	~~11. Bubeck J, Boss K, Krause H, Thies KC. Subcutaneous tunneling of caudal catheters reduces the rate of bacterial colonization to that of lumbar epidural catheters. Anesth Analg 2004; 99: 689-93.~~

	12. Tsui BC, Wagner A, Cave D, Kearny R. Thoracic and lumbar epidural analgesia via the caudal approach using electrical stimulation guidance in pediatric patients: a review of 289 patients. Anesthesiology 2004; 100: 683-9.

	~~13. Chawathe MS, Jones RM, Gildersleve CD, Harrison SK, Morris SJ, Eickmann C. Detection of epidural catheters with ultrasound in children. Paediatr Anaesth 2003; 13: 681-4.~~

	~~14. Bösenberg AT. Epidural analgesia for major neonatal surgery. Paediatr Anaesth 1998; 8: 479-83.~~

	15. Giaufré E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-language society of pediatric anesthesiologists. Anesth Analg 1996; 83: 904-12.

	16. Kozek-Langenecker SA, Marhofer P, Jonas K, Macik T, Urak G, Semsroth M. Cardiovascular criteria for epidural test dosing in sevoflurane- and halothane-anesthetized children. Anesth Analg 2000; 90: 579-83.

	~~17. Tobias JD. Caudal epidural block: a review of test dosing and recognition injection in children. Anesth Analg 2001; 93: 1156-61.~~

	~~18. Armitage EN. Local anaesthetic techniques for prevention of postoperative pain. Br J Anaesth 1986; 58: 790-800.~~

	19. Bösenberg AT, Thomas J, Lopez T, Huledal G, Jeppsson L, Larsson LE. Plasma concentrations of ropivacaine following a single-shot caudal block of 1, 2 or 3 mg/kg in children. Acta Anaesthesiol Scand 2001; 10: 1276-80.

	20. Breschan C, Jost R, Krumpholz R, Schaumberger F, Stettner H, Marhofer P, Likar R. A prospective study comparing the analgesic efficacy of levobupivacaine, ropivacaine and bupivacaine in pediatric patients undergoing caudal blockade. Paediatr Anaesth 2005; 15: 301-6.

	~~21. Menzies R, Congreve K, Herodes V, Berg S, Mason DG. A survey of pediatric caudal extradural anesthesia practice. Paediatr Anaesth 2009; 19: 829-36.~~

	~~22. Walker SM, Westin BD, Deumens R, Grafe M, Yaksh TL. Effects of intrathecal ketamine in the neonatal rat. Evaluation of apoptosis and long-term functional outcome. Anesthesiology 2010; 113: 147-59.~~

	~~23. Walker SM, Yaksh TL. Neuraxial analgesia in neonates and infants: a review of clinical and preclinical strategies for the development of safety and efficacy data. Anesth Analg 2012; 115: 638-62.~~

	~~24. Fellmann C, Gerber AC, Weiss M. Apnoea in a former preterm infant after caudal bupivacaine with clonidine for inguinal herniorrhaphy. Paediatr Anaesth 2002; 12: 637-40.~~

	~~25. Cohen IT. Caudal block complication in a patient with trisomy 13. Paediatr Anaesth 2006; 16: 213-5.~~

WikiSysop at 17:06, 30 October 2021

2021-10-30T17:06:38Z

Show changes