Anesthésie péridurale continue chez l'enfant de moins de deux ans

The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions

“…The dosage recommendation for infants is arbitrary and 0.5 (13) to 0.75 (4) ml·kg −1 of 0.5% bupivacaine, 0.8 ml·kg −1 of 0.25% (14), or 0.1 ml per segment per year of age (3) have all been described. For thoracic and lumbar epidurals, Delleur and Murat (1) used an initial dose of 0.75 ml·kg −1 of 0.25% bupivacaine with or without epinephrine for children <20 kg and 1 ml·10 cm −1 of height for children over 100 cm in height. Concerns about the reduced volume of the epidural space in the thoracic region and the potential for excessive cranial spread of anesthesia have contributed to the recommendation of lower volumes (recommended) for thoracic epidurals in children (14).…”

“…The ideal epidural solution for pediatrics has not been described, with a recent survey showing that at least six combinations are in routine clinical practice (7). Ivani et al (9) investigated three different concentrations of levobupivacaine (0.125%, 0.20%, and 0.25%) in a prospective, randomized, observerblinded study in children (1)(2)(3)(4)(5)(6)(7) year) undergoing subumbilical surgery. A dose-response relationship was observed both with regard to the median duration of postoperative analgesia and the number of patients with evidence of early postoperative motor blockade.…”

“…Continuous epidural anesthesia via the thoracic, lumbar, or sacral route has been commonly used in children since the late 1980s (1–5). The bolus dose (used) to initiate epidural anesthesia in children has been determined by initial work demonstrating the spread of radio‐opaque dye through lumbar epidural catheters (1). The volume required to achieve adequate analgesia and surgical anesthesia has been reported to be 0.15 ml·kg −1 per dermatome level.…”