Abstract
Purpose
The authors prospectively evaluated the use of a continuous caudal epidural infusion of chloroprocaine as an adjunct to genera! anaesthesia during intra-abdominal surgery in neonates.
Clinical features
The technique was used in 25 neonates ranging in age from 1 to 28 days and in weight from 2.2 to 4.9 kg. Following anaesthetic induction and tracheal intubation, an initial bolus dose of chloroprocaine 3% (1 or 1.5 ml · kg−1) was followed by a continuous infusion of 1 or 1.5 ml · kg−1 · hr−1 administered through a caudal epidural catheter. No parenteral opioids were administered. The duration of the surgical procedures varied from one hour five minutes to three hours 15 min. The first three neonates received a bolus dose of 1.0 ml kg−1 followed by an infusion of 1.0 ml · kg−1 · hr−1 chloroprocaine 3%. These three neonates required an additional bolus dose followed by an increase in the infusion to 1.5 ml · kg−1 · hr−1 to provide surgical anaesthesia. Adequate intraoperative anaesthesia was achieved in all 25 neonates with an infusion of 1.5 ml · kg−1· hr−1 of chloroprocaine 3%. This was evidenced by a lack of haemodynamic response to surgical manipulation. No neonate required more than 0.2% isoflurane or 70% nitrous oxide in oxygen. No episodes of haemodynamic instability (decreased blood pressure/bradycardia) related to the caudal epidural anaesthesia were noted. Twenty-three of 25 of the neonates’ tracheas were extubated immediately (within 10 minutes) following the surgical procedure.
Conclusions
Caudal anaesthesia with a continuous infusion of chloroprocaine can be used as an adjunct to general anaesthesia during abdominal surgery in neonates. Our initial experience suggests that the combined technique may eliminate the need for parenteral opioids and limit the intraoperative requirements for inhalational anaesthetic agents.
Résumé
Objectif
Les auteurs évaluent prospectivement l’utilisation d’une perfusion épidurale caudale continue de chlorprocaïne comme anesthésie d’appoint à la générale pendant la chirurgie abdominale du nouveau-né.
Eléments cliniques
Cette technique a été utilisée chez 25 nouveau-nés agés 1 à 28 jours et pesant de 2,2 à 4,9 kg. Après l’induction de l’anesthésie et l’intubation endotrachéale, une premier bolus de chloroprocaine 3% (1,0 ou 1,5 ml · kg−1) a été suivi d’une perfusion continue de 1,0 ou 1,5 ml · kg−1· h−1 administrée par une cathéter épidural caudal. On n’a pas administré de morphiniques parentéraux. La durée des interventions a varié de une heure cinq minutes à trois heures cinq minutes. Les trois premiers nouveau-nés ont reçu un bolus de 1.0 ml · kg−1 suivi par une perfusion de 1,0 ml · kg−1· h−1 de chloroprocaïne 3%. Ces trois nouveau-nés ont eu besoin d’une dose additionnelle en bolus suivie d’une augmentation de la perfusion à 1.5 ml · kg−1· h−1 pour obtenir une anesthésie chirurgicale. Une anesthésie peropératoire adéquate a été obtenue chez les 25 nouveau-nés avec une perfusion de 1.5 ml · kg−1· h−1 de chloroprocaine 3%. Ceci a été confirmé par l’absence de réponse hémodynamique à la manipulation chirurgicale. Aucun des nouveau-nés n’a eu besoin de plus de 0,2% d’isoflurane ou de plus de 70% de protoxyde d’azote en oxygène. On n’a pas constaté d’instabilité hémodynamique (baisse de pression artérielle/bradycardie) en relation avec l’anesthésie caudale. Vingt-trois des 25 patients ont été extubés immédiatement (en moins de 10 minutes) après la chirurgie. l’anesthésie générale pendant la chirurgie abdominale chez le nouveau-né. Notre expérience initiale suggère que cette combinaison de techniques peut éliminer les besoins de morphiniques parentéraux et limiter les besoins peropératoires d’agents anesthésiques inhalatoires.
Conclusion
L’anesthésie caudale avec une perfusion de chloroprocaïne peut être utilisée comme appoint à
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Tobias, J.D., Rasmussen, G.E., Holcomb, G.W. et al. Continuous caudal anaesthesia with chloroprocaine as an adjunct to general anaesthesia in neonates. Can J Anaesth 43, 69–72 (1996). https://doi.org/10.1007/BF03015961
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DOI: https://doi.org/10.1007/BF03015961