Epidural anesthesia in children has long been used as caudal , and intervertebral. In the 1960s and 1970s, dozens of methods were proposed for calculating the doses of local anesthetics needed for children, with formulas and nomograms. Closer to the 1990s, in developed countries, the use of caudal epidural anesthesia for common surgeries (from cutting, which is done in the United States to almost all boys still in the maternity hospital, to hernia repair) in infants, among them many unworn, poorly tolerated general anesthesia. The “weak lungs” of such babies contribute to a higher risk of noskale anesthesia and respiratory complications.
ADVANTAGES
In our experience, even preschoolers are asked to repeat the injection into the epidural or caudal catheter, starting to feel the return of pain.
Epidural blockade provides the ideal analgesic component of intraoperative anesthesia, which can be performed (if the block comes before the start of the operation) without opioids.
The time spent on this blockade is more than repaid by a faster awakening after a very superficial anesthesia, which is practically a medical sleep.
Wonderful relaxation allows you to do without neuromuscular blockers, which also contributes to significantly faster awakening after anesthesia.
Epidural, especially caudal, anesthesia prevents bradycardia and laryngism during manipulations on the anus, mesentery, semen-outflow duct.
Improving blood circulation in the blockade contributes more to stroma healing of postoperative wounds.
“The epidural, including the caudal, blockade immobilizes the operated lower extremity, which is especially valuable after the suturing of the tendons and nerves and after reposition of complex fractures.
Prolonged postoperative analgesia, even after a single blockade, eliminates the need for opioids and, therefore, without excessive sedimentation and vomiting. Analgesia without opioids contributes to the early recovery of activity, the return of appetite and the elimination of the need for postoperative infusions (as the child can eat and drink).
This contributes to the early discharge of the house, which is very important for the child’s psyche. Memories of good pain relief, normal appetite and quick discharge contribute to the best attitude of the child to second operations.
LIMITATIONS
My interns touch the child only after at least 500 epidural blockages in adults.
Not all anesthesiologists (especially children) have these methods. An epidural block requires a little more time than just an induction into anesthesia, even though it pays off with a quick awakening (see “BENEFITS”, paragraph 2).
Since epidural anesthesia is almost always performed for children under anesthesia or deep sedation, two anesthesiologists may be required: one performs a blockade, the other supports anesthesia and monitors the airways. However, after the completion of the block
dy the first anesthesiologist is released. If postoperative analgesia is maintained by a local anesthetic, it is possible (and sometimes necessary) to have weak muscles in the lower limbs. To children of conscious age, whom this may frighten, it is necessary to explain — why and for what.