The incidence of respiratory depression was similar to that described in the literature; it is more frequent in children and adolescents, and with intravenous PCA.

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Rev Bras AnestesiolARTIGO CIENTÍFICO 2006; 56: 6: 583-590 SCIENTIFIC ARTICLE RESUMO Costa VV, Rodrigues MR, Fernandes MCBC, Saraiva RA -Complicações e Seqüelas Neurológicas da Anestesia Regional Realizada em Crianças sob Anestesia Geral. Um Problema Real ou Casos Esporádicos? JUSTIFICATIVA E OBJETIVOS:Tem sido discutido se a técnica de anestesia regional em crianças, que na maioria das vezes é realizada após a anestesia geral, é realmente segura. Há o risco potencial de uma lesão neurológica permanente ou temporária quando o paciente não pode informar eventual parestesia ou dor, durante a realização da anestesia regional, o que gera insegurança por parte dos anestesiologistas. O objetivo deste estudo foi avaliar a prevalência de complicações e seqüelas neurológicas da anestesia regional em crianças sob anestesia geral. MÉTODO:Numa análise prospectiva foram estudadas crianças submetidas a intervenções cirúrgicas ortopédica e plástica reparadora sob anestesia regional associada à anestesia geral. A indução e a manutenção da anestesia foram por vias venosa ou inalatória. Após anestesia geral era realizada anestesia regional e avaliada a existência de complicações imediatas, o número de punções realizadas, complicações de médio prazo e presença de seqüelas neurológicas.RESULTADOS: Num período de 13 meses foram estudadas 499 crianças de ambos os sexos, com idade média de 6,7 anos. A maioria dos pacientes foi submetida à anestesia geral associada à peridural lombar ou caudal. A prevalência de complicação imediata foi 3,6%, sendo a mais freqüente o sangramento no momento da punção. A prevalência de complicações em médio prazo foi 1,1%, sendo a mais freqüente a hipoestesia e não houve seqüela neurológica de longo prazo. CONCLUSÕES:Os resultados do presente estudo são concordantes com os de outros autores com relação à baixa prevalência de complicações da anestesia regional em crianças sob anestesia geral, sem deixar seqüelas neurológicas. Isso pode ser atribuído ao uso de material adequado e a experiência da equipe de anestesia.Unitermos: ANESTESIA, Pediátrica; COMPLICAÇÕES: Seqüela neurológica; TÉCNICAS ANESTÉSICAS, Regional: peridural, lombar, sacra. SUMMARY BACKGROUND AND METHODS:It has been questioned whether regional block in children, which most of the time is done under general anesthesia, is really safe. There is the potential risk of permanent or temporary neurological damage when the patient cannot complain of eventual paresthesia or pain while the block is being performed, making anesthesiologists very insecure. The aim of this study was to evaluate the prevalence of neurological complications and damage of regional block in children under general anesthesia. METHODS:A prospective analysis of children who underwent orthopedic and reconstructive plastic surgeries under regional block associated with general anesthesia was undertaken. Anesthesia was induced and maintained by the intravenous or inhalational route. Regional block was done after general anesthesia and immediate complications, number of punctur...

BACKGROUND AND OBJECTIVES:The development of paraplegia following the insertion of epidural catheter in anesthetized patients raised questions by some authors about the procedure, even without the confirmation that the lesion occurred because the patient was anesthetized. For this reason, we designed this study, with the objective to evaluate the frequency of neurological complications and development of sequelae after thoracic epidural block in patients under general anesthesia. METHODS:Patients undergoing thoracic surgeries from 02/16/ 2004 to 05/30/2006 participated in the study. After monitoring vital signs and the installation of general anesthesia, patients were placed in lateral decubitus for simple or continuous thoracic epidural block. Intercurrences, complications, and technical difficulties were recorded on a special form. Patients were followed postoperatively to detect the development of any signs and symptoms of neurological dysfunction. RESULTS:One hundred and thirteen patients were evaluated and the thoracic epidural catheter was placed in 108 patients. The puncture was considered traumatic, i.e., bleeding at the puncture site and multiple punctures, in 45 patients. Accidental perforation of the dura-mater occurred in two patients. In the immediate postoperative period, a patient complained of tingling in the lower limbs, another patient developed numbness in an upper limb, which resolved after the catheter was removed. Both patients had a single puncture. The other patients did not develop any signs or symptoms of neurologic changes. CONCLUSIONS:The cases studied here did not develop any neurologic complications. When performed judiciously and with specific care, thoracic epidural block can be safely done in the anesthetized patient.