| Caudal Anesthesia for Pediatric Surgery . |
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Jae Kyu Jeon, Jung Gil Jung |
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Department of Anesthesiology, Presbyterian Medical Center, Keimyung University School of Medicine, Taegu, Korea. |
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| Abstract |
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Advantages of caudal anesthesia for pediatric surgery i.e.
clearly defined anatomic landmarks, a simplicity of the technic and high success rate have been reported. However, it has not been popular in clinical practice due to several reasons. First of all, small children do not cooperate with technical procedures. Therefore, an additional measure to provide a cooperative state is needed, such as Pentothal or ketamine injection, or general anesthesia induced beforehand. Secondly, there is no clear determination or an unanimity in anesthetic dosage according to the patient's age or body weight. Lastly, clinical experience and reports have not been enough for clinical practice. In consideration of these points, this report summarizes experience with caudal anesthesia in 230 cases ranging in age from 1 day to 15 years. They were recorded by the Department of Anesthesiology, Dong San Presbyterian Medical Center, for the past two years. Premedication was administered as Demerol 2mg/kg or mixed solution of Demerol 1mg/kg and Vistaril 1mg/kg intramusculary one hour before surgery.
Caudal puncture was performed in the patients left lateral position, following which Pentothal 4mg/kg was administered intravenously. In this study, we have used 3 different concentrations of lidocaine i.e. 2.0% 1.5% and 1.0%. In the first group, 50 patients received adremline premixed with 2% lidocaine solution, 1mg/kg body weight. In the second group, 90 patients received adrenaline premixed with l. 5% lidocaine solution, 1mg/kg body weight. In the 3rd group, 90 patients received adrenaline premixed with 1% lidocaine solution, 1ml/kg body weight. From the result of this study, duration of anesthetic effect is variable and ranges from 2 to 3 hours in the first group with 2% lidocaine-E, 1. 5 to 2. 5 hours in the second group with 1. 5% lidocaine-E and 1.
5 to 2 hours in the third group with 1% lidocaine-E. The authors consider that 1% lidocaine 1ml(10mg)/kg bodyweight is most suitable for the practice of pediatric caudal anesthesia. Blood pressure after caudal analgesia falls slightly which is unimportant and other complications have not been major problems. We came to the concluaion that eaudal anesthesia for pediatric surgery is reliable, simple in technic, favorable to surgeons, nurses and parents and is considered to be a good technic for pediatric anesthesia. |
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