[Continuous peridural anesthesia in children less than 2 years old].
Continuous epidural anaesthesia was carried out in 23 children (age 13.9 +/- 6 months, weight 9.09 +/- 2.5 kg) scheduled for long surgical procedure (soft tissue release for club-foot, "pull-through" for Hirschsprung disease, various genito-urinary procedures). The lumbar epidural space was punctured under general anaesthesia with a 19 G Tuohy needle. A graduated 24 G polyurethane catheter was then inserted and fixed. The local anaesthetic used was bupivacaine 0.25% (0.71 +/- 0.02 ml X kg-1), with or without 1:200,000 adrenaline. Five and 10 min after injection of bupivacaine, heart rate was significantly decreased (p less than 0.05) when compared with pre-induction values, but systolic blood pressure did not change. No other haemodynamic changes occurred. Analgesia was sufficient in all but two cases at incision. Mean duration of surgical procedure was 143 +/- 9.2 min. The time of the first reinjection was significantly longer if bupivacaine with adrenaline was used (116 +/- 2.34 min), when compared with bupivacaine without adrenaline (68.9 +/- 3.92 min) (p less than 0.001). No systemic analgesic was needed during the surgical procedure and anaesthesia was maintained either with halothane (inspiratory fraction less than 0.5%) or enflurane (inspiratory fraction less than 0.8%). All children were extubated at the end of the surgical procedure. The catheter was maintained in 16 children for postoperative analgesia. The first postoperative injection was given 7.1 +/- 0.45 h later. The catheter remained in situ 26.7 +/- 4.1 h. No complication was observed. Thus, during surgery, the need for systemic analgesia was avoided and a rapid and safe postoperative recovery was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)
D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General; D002045:Bupivacaine / Q000008:administration & dosage; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D011184:Postoperative Period
D002045:Bupivacaine
Anesthésie péridurale continue chez l'enfant de moins de deux ans.