Continuous regional anaesthesia in infants

Tobias, Joseph D.; Löwe, Sandra; O'Dell, Nancy; Pietsch, John B.; Neblett, Wallace W.

doi:10.1007/bf03009478

Cited by 26 publications

(14 citation statements)

References 10 publications

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“…2018;9(2):64-67 to potential anesthetic neurotoxicity. Although the use of continuous SA, continuous caudal anesthesia, and SA combined with epidural anesthesia have been previously described ( Table 1, [5][6][7][8][9]), the majority of these reports have used the technique for avoidance of GA in a high-risk child [5][6][7][8][9][10]. Our goal with the reported technique (SA plus placement of a caudal epidural catheter) was to develop a technique that could be offered as a viable alternative to GA for longer surgical procedures, especially given recent concerns of the potential long term neurocognitive effects of general anesthetic agents.…”

Section: Discussionmentioning

confidence: 99%

Combined Spinal and Caudal Epidural Anesthesia for Prolonged Surgical Procedures in Pediatric-Aged Patients: A Report of Two Cases

Geyer¹,

Martin²,

Bhalla³

et al. 2018

J Med Cases

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With emerging evidence that specific anesthetic agents may affect neurocognitive outcomes, there has been renewed interest in the applications of spinal anesthesia in neonates and infants. Because of its short duration of action, spinal anesthesia in infants is generally limited to procedures lasting less than 70 -75 min. To avoid this limitation, we report a technique combining spinal and caudal epidural anesthesia. We present two infants in whom this technique was used to provide surgical anesthesia (without general anesthesia or airway manipulation) for two cases lasting more than 90 min. The technique used is presented, its applications discussed, and previous reports reviewed.

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Section: Discussionmentioning

confidence: 99%

Combined Spinal and Caudal Epidural Anesthesia for Prolonged Surgical Procedures in Pediatric-Aged Patients: A Report of Two Cases

Geyer¹,

Martin²,

Bhalla³

et al. 2018

J Med Cases

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“…Advocates of the nonsurgical approach rely on the very low occurrence of contralateral torsion and the various surgicaland anesthetic-related risks in the neonatal period. 14,15 Performing an orchiopexy in a newborn with delicate anatomy has a higher chance of injury to the single testis. Furthermore, if the parents are educated about how contralateral torsion presents, they could bring the child to the emergency department at the first sign of abnormality and there would be a chance of saving the testis.…”

Section: Discussionmentioning

confidence: 99%

Management of neonatal testicular torsion: Which way to turn?

Guerra

Wiesenthal

Pike

et al. 2013

CUAJ

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Objective: Perinatal testicular torsion (PTT) is a rare event with controversies surrounding its etiology, presentation, surgical management and sequelae. Our survey assessed the preferences of pediatric urologists with regard to its management.Methods: Four cases of unilateral PTT and a questionnaire containing 11 questions about management of common clinical scenarios were mailed to 26 pediatric urologists. The answers were received anonymously and they were analyzed blindly.Results: The response rate was 80% (21/26), with 90% (19/21) of respondents holding academic appointments. In the 2 first cases of PTT with a typical unilateral nonviable testis, 76% (16/21) and 67% (14/21), respectively, opted for surgery. A case of acute postnatal torsion resulted in 100% agreement to urgent scrotal exploration. In the case of an atrophic testis, none of the respondents opted for immediate surgery; yet, 38% (8/21) said they would proceed with a delayed orchiopexy of the contralateral testicle. In the question section, 10% (2/21) responded that they preferred to explore PTT immediately; whereas, 57% (12/21) would delay surgical exploration for a few days until the neonate was better stabilized. One-third of participants (7/21) would not perform a surgical exploration but would just follow the child clinically. A scrotal incision for contralateral orchiopexy was preferred by 52% (11/21), while 48% (10/21) prefer a scrotal approach but would switch to an inguinal incision if a hydrocele were present. Operative intervention was favoured by 80% (8/10) and 46% (5/11) of those with less than and greater than 10 years of practice, respectively.Conclusion: This survey revealed that 67% (14/21) of respondents preferred immediate exploration of a torted testis and contralateral orchiopexy, compared with the nonoperative approach. Scrotal incision for the exploration was preferred by most respondents. There was a trend to choose less aggressive treatment as the years of practice increase. Studies of more robust design, such as randomized controlled trials, are necessary to determine the natural history and outcomes of this uncommon type of testicular torsion.

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“…[2][3][4][5][6]. Patients who undergo CCAM resection usually have an epidural catheter inserted via the sacral hiatus and advanced to the thoracic level after general anesthesia is induced and before the surgical procedure commences.…”

mentioning

confidence: 99%