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209
Posters
209. Fluoroscopic identification of lumbar epidural catheter in infant and small children Kil1,2,
Kwak1,
Cho1,
Chun1
H.K. H.J. J.E. D.H. [email protected] 1Department of Anesthesiology and Pain Medicine, Seoul, South Korea, 2Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea Background: Although the epidural catheterization via caudal route has been shown to be feasible in small children, it is not recommended for continuous postoperative analgesia, because the risk of infection is greater1. The aim of this study was to evaluate the location of epidural 20 G catheter and the extent of spread of dye after lumbar epidural catheterization in small children. Methods: In 30 patients, aged 19 days–53 months, undergoing urological surgery, were studied. After anesthesia, epidural cannulation was performed at L4-5. The epidural catheter 20 G was threaded to cephalad in 17 and caudad in 13. Under the fluoroscopy, OmnipaqueTM was injected until the catheter was identified. After the first image was taken, additional dye 0.1 ml/kg was injected and another image was taken. The images were evaluated through PACS. Results: The catheters were circled itself, formed a figure eight, or turned downward in 7 of 17 cephalad cases (Figure).
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Pediatrics
59
278. Pediatric spinal anesthesia S. Chandra [email protected] Head of Department of Anesthesiology and Intensive Care Unit, Cipto Mangunkusumo Hospital, University of Indonesia, Medical Faculty, Jakarta, Indonesia Background: The use of regional anesthetic techniques in infants and children has become increasingly accepted as standard of care during the final decades of the 20th century. Also spinal anesthesia has been successfully performed in children since this decade. This study is the first to evaluated the proper techniques and clinical effect of drugs used in pediatric spinal anesthesia in Indonesia. The aim is to provide a standard procedure of pediatric. Methods: Thirty eight children aged 1.5 to 14 year scheduled for surgery below the umbilicus with spinal anesthesia, were enrolled. Plain solution of levobupivacaine 5 mg/mL or plain solution of bupivacaine 5 mg/mL or hyperbaric solution of bupivacaine was injected in a dose 0.3-0.5 mg/kg via L3-4 or L4-5 interspace with the patient in the lateral decubitus position using a 27 -gauge spinal needle. After injection, the patients were placed supine. The spread and duration of sensory analgesia and the degree of motor block were recorded. Results: The demographic data of the children are shown in the table. Urologic surgery (n ⫽ 16), digestive surgery (n ⫽ 17) and orthopedic surgery (n ⫽ 5) were the most common procedures performed. The spinal anesthesia was successful in all of the children performed. Most of the children below 6 years old required supplemental sedation using halothane via face mask prior to performing the block and small concentration of halothane during the operation. Determining the level of the block still remaining a difficult question to answer, especially in the awake preverbal child. Use of safety pin to determine the dermatome distribution of anesthesia only causes anxiety or crying, and light touch or cold versus warm discrimination often yields ambiguous results. Conclusion: It is a general impression that infants and children who receive a spinal anesthesia has benefit in many ways. Reduction of intraoperative anesthetic requirement and effective postoperative analgesia, they return more rapidly to their preoperative state and are comfortable with minimal sedation.
The spread of dye was cylindrical to the upper and lower extension with paravertebral spread, but the degree of spread was various in every cases. Conclusions: In infant and children, the catheter could be placed in various figures in epidural space with lumbar approach, which could be a trouble to provide an effective postoperative analgesia and to remove the catheter. In small children, it is preferable to perform epidural cannulation at the level considering surgical site for an effective postoperative analgesia. And also, it is important to verify the placement of the catheter radiologically.
Reference 1. Dalens B. L’anesthesie locolegionale en pediatrie. Ann Fr Anesth Reanim 1989; 8: 51-66.
209. Fluoroscopic identification of lumbar epidural catheter in infant and small children Kil1,2,
Kwak1,
Cho1,
Chun1
H.K. H.J. J.E. D.H. [email protected] 1Department of Anesthesiology and Pain Medicine, Seoul, South Korea, 2Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea Background: Although the epidural catheterization via caudal route has been shown to be feasible in small children, it is not recommended for continuous postoperative analgesia, because the risk of infection is greater1. The aim of this study was to evaluate the location of epidural 20 G catheter and the extent of spread of dye after lumbar epidural catheterization in small children. Methods: In 30 patients, aged 19 days–53 months, undergoing urological surgery, were studied. After anesthesia, epidural cannulation was performed at L4-5. The epidural catheter 20 G was threaded to cephalad in 17 and caudad in 13. Under the fluoroscopy, OmnipaqueTM was injected until the catheter was identified. After the first image was taken, additional dye 0.1 ml/kg was injected and another image was taken. The images were evaluated through PACS. Results: The catheters were circled itself, formed a figure eight, or turned downward in 7 of 17 cephalad cases (Figure).
•
Pediatrics
59
278. Pediatric spinal anesthesia S. Chandra [email protected] Head of Department of Anesthesiology and Intensive Care Unit, Cipto Mangunkusumo Hospital, University of Indonesia, Medical Faculty, Jakarta, Indonesia Background: The use of regional anesthetic techniques in infants and children has become increasingly accepted as standard of care during the final decades of the 20th century. Also spinal anesthesia has been successfully performed in children since this decade. This study is the first to evaluated the proper techniques and clinical effect of drugs used in pediatric spinal anesthesia in Indonesia. The aim is to provide a standard procedure of pediatric. Methods: Thirty eight children aged 1.5 to 14 year scheduled for surgery below the umbilicus with spinal anesthesia, were enrolled. Plain solution of levobupivacaine 5 mg/mL or plain solution of bupivacaine 5 mg/mL or hyperbaric solution of bupivacaine was injected in a dose 0.3-0.5 mg/kg via L3-4 or L4-5 interspace with the patient in the lateral decubitus position using a 27 -gauge spinal needle. After injection, the patients were placed supine. The spread and duration of sensory analgesia and the degree of motor block were recorded. Results: The demographic data of the children are shown in the table. Urologic surgery (n ⫽ 16), digestive surgery (n ⫽ 17) and orthopedic surgery (n ⫽ 5) were the most common procedures performed. The spinal anesthesia was successful in all of the children performed. Most of the children below 6 years old required supplemental sedation using halothane via face mask prior to performing the block and small concentration of halothane during the operation. Determining the level of the block still remaining a difficult question to answer, especially in the awake preverbal child. Use of safety pin to determine the dermatome distribution of anesthesia only causes anxiety or crying, and light touch or cold versus warm discrimination often yields ambiguous results. Conclusion: It is a general impression that infants and children who receive a spinal anesthesia has benefit in many ways. Reduction of intraoperative anesthetic requirement and effective postoperative analgesia, they return more rapidly to their preoperative state and are comfortable with minimal sedation.
The spread of dye was cylindrical to the upper and lower extension with paravertebral spread, but the degree of spread was various in every cases. Conclusions: In infant and children, the catheter could be placed in various figures in epidural space with lumbar approach, which could be a trouble to provide an effective postoperative analgesia and to remove the catheter. In small children, it is preferable to perform epidural cannulation at the level considering surgical site for an effective postoperative analgesia. And also, it is important to verify the placement of the catheter radiologically.
Reference 1. Dalens B. L’anesthesie locolegionale en pediatrie. Ann Fr Anesth Reanim 1989; 8: 51-66.