title: [Risk management in pediatric regional anesthesia].
abstract: Although regional analgesia exerts beneficial effects not only for reducing the stress responses during surgery but also for pain relief after surgery, adverse incidents have occurred even at a low rate. Severe complications such as spinal penetration during epidural block can devastate not only patients, families but also our staffs and we have to avoid such disastrous result absolutely. Retrospective and prospective studies are seldom able to register the precise incident rate of severely injured complication related to regional blocks because the rate is very low. Therefore we have to glean any information from case reports and studies as much as possible. A study has clarified that more epidural cases might be able to reduce the rate of injuring and younger age group is apt to be injured especially in the thoracic region. The report of five cases of severe injuring during epidural blocks from Giaufré's study gave us some important advices. We should not perform epidural blocks in the very young age group and not use air while confirming epidural space by loss of resistance technique and local anesthetics containing even low concentrations of epinephrine. We have to select patients carefully and balance the risk and benefits with the patients.
authors.affiliation: Department of Anesthesia, Shizuoka Children's Hospital, Shizuoka 420-8660.
authors.forename: Yoh
authors.initials: Y
authors.lastname: Horimoto
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000737:chemistry; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D004837:Epinephrine; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D018570:Risk Assessment; D012308:Risk Management; D013119:Spinal Cord Injuries / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D000779:Anesthetics, Local; D004837:Epinephrine