title: Caudal anaesthesia under sedation: a prospective analysis of 512 infants and children.
abstract: BACKGROUND
  Caudal anaesthesia is a common procedure for infants and children undergoing subumbilical surgery, mostly performed in conjunction with general anaesthesia. Even if complications are rare, the risk of postoperative apnoea is significant, especially in infants born preterm or operated upon before 46 weeks of post-conceptual age. Caudal block in sedated, spontaneously breathing patients might be a safe alternative.
  
  
  METHODS
  We investigated 512 infants and children. Premedication consisted of midazolam, sedation was induced with i.v. nalbuphine 0.1 mg kg(-1) and propofol 1 mg kg(-1), and maintained with propofol 5 mg kg(-1) h(-1) in children, if necessary. Caudal block was performed with ropivacaine 1 ml kg(-1) (0.2% or 0.35%).
  
  
  RESULTS
  Data were obtained from 228 infants and 284 children. Median (IQR) age was 1.3 (0.2, 3.4) yr; median body weight was 10.0 (4.8, 15.3) kg. Two hundred and thirty-three (45.51%) were born preterm and 47 (9.18%) were operated upon before 46 weeks of post-conceptual age. Caudal block was successful in 98.05% and adverse events occurred in 7.03% patients. The incidence of adverse events was not higher in born preterm or operated upon before 46 weeks of post-conceptual age than in term born infants (P=0.35 and 0.35, respectively), or in infants vs children (P=0.61). There was no correlation between the incidence of adverse events and continuous sedation (P=0.07), coexisting diseases (P=0.11), or ASA classification (P=0.33).
  
  
  CONCLUSIONS
  Caudal anaesthesia under sedation is associated with high success rates and a low incidence of adverse events, but requires careful and anticipatory perioperative management.
authors.affiliation: Department of Anaesthesia, General Intensive Care and Pain Control, Medical University of Vienna, General Hospital, Waehringer Guertel 18-20, Vienna, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Brenner
authors.forename: S C
authors.initials: SC
authors.lastname: Kettner
authors.forename: P
authors.initials: P
authors.lastname: Marhofer
authors.forename: D
authors.initials: D
authors.lastname: Latzke
authors.forename: H
authors.initials: H
authors.lastname: Willschke
authors.forename: O
authors.initials: O
authors.lastname: Kimberger
authors.forename: D
authors.initials: D
authors.lastname: Adelmann
authors.forename: A-M
authors.initials: AM
authors.lastname: Machata
mesh_terms: D000005:Abdomen / Q000601:surgery; D000701:Analgesics, Opioid; D000763:Anesthesia, Caudal / Q000009:adverse effects / Q000379:methods*; D002648:Child; D016292:Procedural Sedation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009266:Nalbuphine; D011292:Premedication / Q000379:methods; D015742:Propofol; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009266:Nalbuphine; D015742:Propofol