Caudal midazolam does not affect sevoflurane requirements and recovery in pediatric day‐case hernioplasty

Hong, Jeong Yeon; Lee, I. H.; Shin, Seokyung; Park, E. Y.; Ban, So Young; Cho, J. E.; Kil, Hae Keum

doi:10.1111/j.1399-6576.2008.01727.x

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…Addition of midazolam 50 μg/kg to caudal local anesthetic prolongs analgesia and increased sedation in children aged 1–12 years 154 . Some reports employ a preservative-free solution 148,155 , but others give no details of the pharmaceutical preparation 154,156 although one reported using a solution with a pH of 6.2 rather than 3.3–3.9 as used in previous studies 157 . Solutions of 0.1–0.5% midazolam were administered with 0.5–1.0ml/kg of local anaesthetic or saline resulting in final concentrations approximating 50–100 mcg/ml 154,155,157,158 .…”

Section: Clinical Choice Of a Spinal Analgesic: Efficacymentioning

confidence: 99%

Neuraxial Analgesia in Neonates and Infants

Walker

Yaksh

2012

Anesthesia &Amp; Analgesia

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Neuraxial agents provide robust pain control, have the potential to improve outcomes, and are an important component of the perioperative care of children. Opioids or clonidine improve analgesia when added to perioperative epidural infusions; analgesia is significantly prolonged by addition of clonidine, ketamine, neostigmine or tramadol to single shot caudal injections of local anesthetic; and neonatal intrathecal anesthesia/analgesia is increasing in some centers. However, it is difficult to determine the relative risk-benefit of different techniques and drugs without detailed and sensitive data related to analgesia requirements, side-effects, and follow-up. Current data related to benefits and complications in neonates and infants are summarized, but variability in current neuraxial drug use reflects the relative lack of high quality evidence. Recent preclinical reports of adverse effects of general anesthetics on the developing brain have increased awareness of the potential benefit of neuraxial anesthesia/analgesia to avoid or reduce general anesthetic dose requirements. However, the developing spinal cord is also vulnerable to drug-related toxicity, and although there are well-established preclinical models and criteria for assessing spinal cord toxicity in adult animals, until recently there had been no systematic evaluation during early life. Therefore, the second half of this review presents preclinical data evaluating age-dependent changes in the pharmacodynamic response to different spinal analgesics, and recent studies evaluating spinal toxicity in specific developmental models. Finally, we advocate use of neuraxial agents with the widest demonstrable safety margin and suggest minimum standards for preclinical evaluation prior to adoption of new analgesics or preparations into routine clinical practice.

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Section: Clinical Choice Of a Spinal Analgesic: Efficacymentioning

confidence: 99%

Neuraxial Analgesia in Neonates and Infants

Walker

Yaksh

2012

Anesthesia &Amp; Analgesia

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“…Previous studies suggest that an opioid-sparing effect can be achieved postoperatively using a pharmacologically diverse variety of non-opioid adjuvants i.e., clonidine [14], dexmedetomidine [15], dexamethasone [16], magnesium [17], ketamine [18], midazolam [19]. Also neostigmine as adjuvant to caudally administered local anesthetic significantly increases the pain relief time in routine clinical practice in pediatric patients [20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Caudal Neostigmine and Bupivacaine Facilitates Early Extubation and Provides Prolonged Postoperative Analgesia in Children Undergoing Open Heart Surgery

abdalla¹

2015

J Anesth Clin Res

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Objective: This study was designed to examine the effect of single shot of caudal neostigmine with bupivacaine on early extubation versus standard intravenous fentanyl regimen without caudal block. Design: Prospective, randomized double blind controlled clinical trial Setting of the study: Children University Hospital Patients: 80 children (4 to 12 years) undergoing correction of congenital heart defects Methods: Patients were randomized into two equal groups (caudal neostigmine group and non-caudal group); Anesthesia was provided with sevoflurane, midazolam, plus fentanyl 5 mcg/kg and cisatracurium 0.1 mg/kg and maintained with sevoflurane, fentanyl 1 mcg/kg/h. and cisatracurium 0.05 mg/kg. In caudal group; caudal block with bupivacaine (0.125%) in a dose of 1.5 ml/kg plus neostigmine in a dose of 2 mcg/kg was performed after endotracheal intubation in the caudal group only. In non-caudal group intravenous fentanyl was continuously infused postoperatively until weaning from mechanical ventilation. Measurements and Main Results: Both groups were comparable as regard age, sex, weight, and bypass and aortic cross clamp times. In the caudal neostigmine group patients were early extubated, with shorter Pediatric Intensive Care Unit (PICU) stay and prolonged postoperative analgesia. Eleven patients had nausea and vomiting in caudal versus four in non-caudal group. Conclusion: Single dose of caudal bupivacaine with neostigmine provided optimum conditions for extubation and good control of postoperative pain in children undergoing cardiac surgery.

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