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Paediatric spinal anaesthesia: Difference between revisions
→TECHNIQUE OF SA IN CHILDREN
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There should be an assistant for the anaesthetist to help with preparation of the equipment, positioning and holding the child during insertion of the SA. All drugs and equipment should be prepared and checked prior to starting. Full barrier aseptic technique should be used, with a sterile work surface for equipment. | There should be an assistant for the anaesthetist to help with preparation of the equipment, positioning and holding the child during insertion of the SA. All drugs and equipment should be prepared and checked prior to starting. Full barrier aseptic technique should be used, with a sterile work surface for equipment. | ||
{| class="wikitable" | |||
|+Table 2. <i>Dose of local anaesthetic for SA in children</i> | |||
|'''Weight''' | |||
|'''<5Kg''' | |||
|'''5 to 15Kg''' | |||
|'''>15Kg''' | |||
|- | |||
|Isobaric or hyperbaric bupivacaine 0.5% | |||
|1mg.kg-1 (0.2ml.kg-1) | |||
|0.4mg.kg-1 (0.08ml.kg-1) | |||
|0.3mg.kg-1 (0.06ml.kg-1) | |||
|- | |||
|Isobaric or hyperbaric tetracaine 0.5 % | |||
| | |||
|0.4mg.kg-1 (0.08ml.kg-1) | |||
|0.3mg.kg-1 (0.06ml.kg-1) | |||
|} | |||
Figure 1. Lateral position to perform SA in 4kg newborn | |||
The operator should use sterile gloves, gown and mask and the patient’s skin should be cleaned with an alcoholic solution such as 0.5% or 2% chlorhexidine (+/- iodine). The skin should be allowed to dry and a sterile sheet should be placed over the child with a hole to reveal the field. The dose of local anaesthetic solution is calculated according to the weight of the child and is shown in Table 2;5 the drugs should be drawn into a 1-2ml syringe as appropriate and placed on the sterile work surface in preparation for use. | The operator should use sterile gloves, gown and mask and the patient’s skin should be cleaned with an alcoholic solution such as 0.5% or 2% chlorhexidine (+/- iodine). The skin should be allowed to dry and a sterile sheet should be placed over the child with a hole to reveal the field. The dose of local anaesthetic solution is calculated according to the weight of the child and is shown in Table 2;5 the drugs should be drawn into a 1-2ml syringe as appropriate and placed on the sterile work surface in preparation for use. | ||
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<i>Postoperative care</i> | <i>Postoperative care</i> | ||
In our hospital, children are discharged from the post anaesthesia care unit when the block disappears, i.e. free lower limb movement returns. Children are allowed to feed on demand, provided there are no surgical restrictions. All infants younger than 60 weeks post conception are monitored on the ward for 24 hours after SA. | In our hospital, children are discharged from the post anaesthesia care unit when the block disappears, i.e. free lower limb movement returns. Children are allowed to feed on demand, provided there are no surgical restrictions. All infants younger than 60 weeks post conception are monitored on the ward for 24 hours after SA. | ||
== COMPLICATIONS OF SA == | == COMPLICATIONS OF SA == | ||