Epidural analgesia in the surgery of congenital tracheal stenosis: slide tracheoplasty on cardiopulmonary bypass.
Epidural analgesia in children is highly effective and safe; however, it has not enjoyed great popularity in surgery that requires cardiopulmonary bypass. A major concern is the possibility of damage to blood vessels with the epidural needle or catheter and epidural hematoma formation. There seems to be a low incidence of epidural hematoma if certain guidelines are followed, so that in children, epidural analgesia can be used in selected patients, with safety, when surgical repair requires cardiopulmonary bypass. Epidural morphine has been used for clinical pain relief in pediatric cardiac surgery. Improved pulmonary function, suppressed hormonal and metabolic stress responses, easy early tracheal extubation, and good analgesia and sedation that allows neurological examination to alert any possibles hidden complications, are the advantages. A dedicated medical team is essential in the perioperative management to achieve maximum benefit for these patients.
Vilà
Ramon
R
Department of Anaesthesia, Hospital Infantil Vall d'Hebron, Autonomous University of Barcelona, Catalonia, Spain. 9372rvp@comb.es
Marhuenda
Claudia
C
Gonçalves
Arturo
A
Gil-Jaurena
Juan M
JM
Pellicer
Marc
M
Suescum
Maria C
MC
Miró
Lluis
L
D015360:Analgesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000295:instrumentation; D006801:Humans; D007223:Infant; D008297:Male; D011182:Postoperative Care; D015619:Respiratory System Abnormalities; D014132:Trachea / Q000601:surgery*; D014135:Tracheal Stenosis / Q000151:congenital / Q000601:surgery*