This is the first published report of the incidence of unexpected DBMV among healthy pediatric patients.

Although we recognize that it is possible that there were changes in care not related specifically to the introduction of a dedicated APS that occurred in our institution that resulted in improvements in general postoperative care and in length of stay, our study did show that having an organized APS allowed to significantly decrease the incidence of postoperative oxygen desaturation and to decrease the hospital length of stay by 1 day.

Background: Caudal block with the use of an adequate dose of bupivacaine, and combined with a general anesthesia (GA) provides intra-operative anesthesia and postoperative analgesia. No study has examined the use of 3 mg/Kg bupivacaine for intra-abdominal surgery in pediatric patients in clinical practice. Objective: Compare the effectiveness of three mg/Kg bupivacaine administered as 1.2 mL/Kg 0.25% bupivacaine and 1.5 mL/Kg 0.2% bupivacaine for caudal block in pediatric patients undergoing intra-abdominal surgery. Methods: In a randomized, double-blinded clinical trial, patients (age: 6 months -7 years) were randomly assigned into one of two groups (n= 40) to receive a caudal block with either 1.2 mL/Kg 0.25% bupivacaine (group A) or 1.5 mL/Kg 0.2% bupivacaine (group B), with morphine 50 μg/Kg. The effectiveness of intra-operative anesthesia, complications, and requirements for post-operative analgesia were evaluated. Results: Data were available for 74 pediatric patients. There were no significant differences between the two groups in baseline characteristics. Intra-operatively, the numbers of patients who required a rescue analgesic were comparable between the groups (67% in group A and 63% in group B). The numbers of patients who required a muscle relaxant were also comparable between groups (49% in group A and 57% in group B). The time from discontinuation of the volatile anesthetic to extubation was significantly shorter in group B (9.5±1.1 minutes) than group A (14.3±0.9 minutes), p < 0.01. The time from initial caudal block to the first analgesic required in the recovery room was significantly longer in group B (202±45 minutes) than in group A (149±27 minutes). The time from the caudal block to the first analgesic required in the ward was significantly longer in group B (10.4±3.1 hours) than in group A (8.2±2.0 hours). Overall fentanyl requirements were comparable between groups, 52.5±2.0 μg in group A and 49.5±3.0 μg in group B. Conclusion: Caudal block by either 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg or 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided effectively equivalent intra-operative analgesia and surgical relaxation. However, a caudal block with 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided superior prolonged analgesic advantages compared with 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg in pediatric patients undergoing intra-abdominal surgery.