[Thoracic peridural anesthesia in childhood].

Abstract

Local and regional anesthesia, especially peridural anesthesia, is a rarely used method in pediatric anesthesia. That cannot be explained by children's physis, since it shows in general neither a different margin of therapeutic safety nor a different effect/side-effect ratio than in adult. Nevertheless, psychologic alteration of children through operation and anesthesia necessitate simultaneous endotracheal narcosis during peridural anesthesia. The following characteristics of regional anesthesia in children should be regarded: The younger the child the higher is the ratio between extracellular water and body weight. Thus higher doses of local anesthetics in relation to body weight can be applied. The smaller diameters of children's nerves support diffusion of local anesthetics and, therefore, allow the use of lower concentrations. Increased perfusion of tissues and high cardiac output lead to rapid resorption and accelerated increase of anesthetic blood levels. This disadvantage can be avoided by use of lower concentrations of anesthetics. Even an extended sympathetic block during peridural anesthesia hardly causes any negative effect on circulatory parameters. We performed thoracic epidural anesthesia during thoracic and upper abdominal surgery in 40 5-15-year-old children. In many of the patients additional risks had already occurred through atelectasis or lung fibrosis. Before introducing the epidural catheter we always carried out endotracheal anesthesia with relaxation to achieve perfect conditions for the puncture. This puncture was made between Th 6 and 10, mostly between Th 7/8, the patient lying on one side. An extension of analgesia between Th 3 and Th 12 was intended, which, however, could not be controlled because of simultaneous endotracheal anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)