title: Dexmedetomidine sedation combined with caudal anesthesia for lower abdominal and extremity surgery in ex-preterm and full-term infants.
abstract: BACKGROUND
  Awake caudal anesthesia is a potentially attractive option, because the administration of general anesthesia is associated with a high rate of respiratory complications and hemodynamic disturbances and potential neurotoxic effects. To facilitate the caudal puncture and subsequent surgical intervention, additional sedatives are commonly administered.
  
  
  OBJECTIVE
  We aimed to establish a new, safe, and effective anesthetic procedure for very young children with comorbidities.
  
  
  METHODS
  We retrospectively analyzed 23 children who underwent lower abdominal or lower extremity surgery with dexmedetomidine sedation and caudal anesthesia from January 2015 to August 2015. Dexmedetomidine was initiated with a total bolus infusion of 0.7-1.1 μg·kg-1followed by a continuous infusion of 1 μg·kg-1·h-1. Bupivacaine (2.5 mg·kg-1) was supplemented with 5-10 μg·kg-1epinephrine to strengthen and prolong motor block. According to maturity at birth, two groups were defined: ex-preterm and full-term infants.
  
  
  RESULTS
  There were 12 ex-preterm and 10 full-term infants available for analysis. The median postmenstrual age was 44 (38-52) weeks in ex-preterm and 46.5 (40-72) weeks in full-term infants. Without any additional intervention, surgery was successfully accomplished in 82% of all cases. While respiratory complications were not a problem, hemodynamic disturbances commonly occurred. Maximum decreases in heart rate (HR) of 30% were accompanied by maximum decreases in mean arterial pressure (MAP) of 38%. No infant had a heart rate below 100 bpm. MAP declined in one ex-preterm infant to a minimum value of 32 mmHg.
  
  
  CONCLUSIONS
  Caudal anesthesia combined with dexmedetomidine sedation is an effective anesthetic technique for lower abdominal and extremity surgery in ex-preterm and full-term infants with severe comorbidities.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Katrin
authors.identifier: http://orcid.org/0000-0002-0621-8153
authors.initials: K
authors.lastname: Waurick
authors.affiliation: Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sauerland
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Goeters
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000763:Anesthesia, Caudal; D000779:Anesthetics, Local; D062186:Arterial Pressure / Q000187:drug effects; D002045:Bupivacaine; D015897:Comorbidity; D020927:Dexmedetomidine; D005121:Extremities / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D002045:Bupivacaine
keywords: caudal anesthesia; dexmedetomidine; infants; neonates; regional anesthesia; sedation