title: Caudal anesthesia in a patient with peritonitis: Is it safe??
abstract: Neuraxial anesthesia combined with general anesthesia has become a widely accepted method of providing effective postoperative analgesia and decreasing intraoperative anesthetic needs in the pediatric population. In clinical practice, there still appears to be hesitancy for the use of a neuraxial technique (spinal or epidural) in patients at risk for bacteremia or with an on-going systemic infection. However, evidence-based medicine lacks any data to support an increase in the risk of infectious complications following neuraxial anesthesia. We present two pediatric patients with intra-abdominal infectious processes who received caudal epidural blockade for postoperative operative analgesia. The use of neuraxial techniques in patients at risk for bacteremia is reviewed, evidence-based medicine regarding the risks of infection discussed, and the potential favorable effects of neuraxial blockade on the neurohumoral response to sepsis and the systemic inflammatory responses presented.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, USA.
authors.forename: H
authors.initials: H
authors.lastname: Kako
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
authors.forename: M
authors.initials: M
authors.lastname: Hakim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kundu
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, Ohio, USA.
authors.forename: T D
authors.initials: TD
authors.lastname: Tobias
keywords: Caudal anesthesia; pediatrics; peritonitis