A Review of Regional Anesthesia in Infants

Boretsky, Karen

doi:10.1007/s40272-019-00360-8

Cited by 17 publications

(32 citation statements)

References 138 publications

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“…Several developmental factors increase the risk of LA accumulation in neonates and infants 3 including the presence of immature organ systems, coupled with reduced plasma proteins levels, which can result in an accumulation of amide LA and toxicity.…”

Section: Discussionmentioning

confidence: 99%

Local anesthetic toxicity following erector spinae plane block in a neonate: A case report

Crowe

Mislovic

2021

Pediatric Anesthesia

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A 6‐day‐old, 4.0 kg neonate presented with intestinal malrotation, necessitating laparotomy. Intra‐operatively, an ultrasound‐guided erector spinae plane block was performed under general anesthesia with administration of 1 mg/kg levobupivacaine. Minutes following this, acute cardiac compromise was evident from a tapering end‐tidal carbon dioxide, falling oxygen saturations, and low blood pressure. Intravenous epinephrine 1 mcg/kg was administered, with some hemodynamic improvement. Intralipid (1.5 ml/kg) was given, with a return to normal hemodynamic parameters. This is the first case report of suspected local anesthetic toxicity in a neonate following an erector spinae plane block.

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Section: Discussionmentioning

confidence: 99%

Local anesthetic toxicity following erector spinae plane block in a neonate: A case report

Crowe

Mislovic

2021

Pediatric Anesthesia

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“…Contraindications to epidural analgesia are thrombocytopenia, heparin therapy, and intraspinal disease or surgery. Coagulopathy and bacteremia are relative contraindications, when present, risks and benefits need to be carefully considered [ 27 ].…”

Section: Postoperative Pain Managementmentioning

confidence: 99%

“…It is more common in infants and special attention should be paid to this age group. Guidelines for treatment are available and include the administration of intralipid at the first suggestion of toxicity [ 27 ].…”

Section: Postoperative Pain Managementmentioning

confidence: 99%

Anesthesia in Children with Neuroblastoma, Perioperative and Operative Management

et al. 2021

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Neuroblastoma (NB) is the most common extracranial, solid, pediatric malignancy and, despite the constant progress of treatment and development of innovative therapies, remains a complex, challenging disease causing major morbidity and mortality in children. There is significant variability in the management of neuroblastoma, partially due to the heterogeneity of the clinical and biological behavior, and partially secondary to the different approaches between treating institutions. Anesthesia takes an integral part in the multidisciplinary care of patients with NB, from diagnosis to surgery and pain control. This paper aims to review and discuss the critical steps of the perioperative and operative management of children undergoing surgery for neuroblastoma. Anesthesia and analgesia largely depend on tumor location, surgical approach, and extension of the surgical dissection. Attention should be paid to the physio-pathological changes on cardiovascular, gastrointestinal, and immune systems induced by the tumor or by chemotherapy. At the time of surgery meticulous patient preparation needs to be carried out to optimize intraoperative monitoring and minimize the risk of complications. The cross-sectional role of anesthesia in cancer care requires effective communication between all members of the multidisciplinary team.

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“…Bupivacaine accumulates with continuous infusion and 2-chloroprocaine can be used as an alternative. LAST has the highest incidence in infants less than 6 months of age and is associated with bolus dosing and penile nerve blocks [21].…”

Section: Age Related Factorsmentioning

confidence: 99%

Local Anesthetic Systemic Toxicity

Garg¹,

Soni²,

Karnawat³

2020

Topics in Local Anesthetics

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Local anesthetics are used very often in medicine and dentistry. They have few adverse effects, but the increased use of these drugs has resulted in a higher incidence of local and systemic anesthetic toxicity (LAST). From the initial symptoms to the deleterious effects on cardiac and the central nervous system, LAST is an important consequence of which we should be aware. LAST is known since the introduction and use of local anesthetics; it was originally associated with seizures and respiratory failure. However, in the 1970s, side effects on the heart were also identified, as the fatal cardiac toxicity associated with bupivacaine was discovered in healthy patients. Prevention and safe administration of regional anesthesia remains primary factors in the avoidance of the toxicity of these drugs. When a patient has LAST, treatment should be started immediately to reduce seizures. If there is cardiac arrest, follow ACLS guidelines. Intravenous lipids improve cardiac conduction, contractility and coronary perfusion by removing liposoluble local anesthetic from cardiac tissue.

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A Review of Regional Anesthesia in Infants

Cited by 17 publications

References 138 publications

Local anesthetic toxicity following erector spinae plane block in a neonate: A case report

Local anesthetic toxicity following erector spinae plane block in a neonate: A case report

Anesthesia in Children with Neuroblastoma, Perioperative and Operative Management

Local Anesthetic Systemic Toxicity

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