Galante Dario, Pellico Giuseppe, Meola Salvatore, Caso Antonio, De Capraris Antonella, Milillo Rosella, Mirabile Cristian, Olivieri Maria, Cinnella Gilda, Dambrosio Michele
University Department of Anesthesia and Intensive Care, University Hospital Ospedali Riuniti of Foggia, Italy, University of Foggia, Italy.
Paediatr Anaesth. 2008 Nov;18(11):1066-74. doi: 10.1111/j.1460-9592.2008.02774.x.
The aim of this study is to determine if there are significant differences in hemodynamic effects between combined general-regional anesthesia using levobupivacaine 0.25% 2 ml x kg(-1) via the caudal route in comparison with balanced general anesthesia using continuous infusion of remifentanil in young children undergoing genitourinary surgery.
62 ASA I-II pediatric patients (12 female, 50 male) aged 6 months to 7 years undergoing genitourinary surgery were included in the study. Patients were randomly allocated into one of two groups of 31 patients each. Group Caud received caudal blockade with levobupivacaine 0.25% 2 mg x kg(-1) in combined general-regional anesthesia and Group Gen received balanced general anesthesia with remifentanil. The noninvasive hemodynamic parameters were measured in each group 5 min after induction of general anesthesia or caudal block (Tcaud), after further 5 min coincident with skin incision (Tsi), 10 min after skin incision (T10i), at the end of surgical procedure (Tend). The time between Tcaud and Tsi was 10 min and the measurements during the interval time T10i-Tend were performed every 15 min according to the duration of surgical procedures.
There was a decrease in all measured hemodynamic parameters at skin incision. The decreases occurred in both groups with those in the caudal group occurring at skin incision and those in the balanced anesthesia group occurring at 10 min after skin incision. These variations showed no significant differences for any of the stated outcomes; neither between the groups at each time point nor in the caudal in comparison with baseline measurements.
Using transesophageal Doppler no differences in hemodynamic parameters could be detected between balanced general anesthesia with either caudal levobupivacaine or remifentanil infusion. Both techniques showed good hemodynamic stability with only minor changes from baseline over time which are unlikely to be of clinical significance except possibly in patients with preexisting cardiovascular compromise. Other studies with noninvasive monitoring in a larger population are required to better understand the consequences of caudal blockade on CO and on regional blood flow in infants.
本研究旨在确定，对于接受泌尿生殖系统手术的幼儿，通过骶管途径使用0.25%左旋布比卡因2 ml·kg⁻¹进行全身 - 区域联合麻醉与使用瑞芬太尼持续输注进行平衡全身麻醉相比，血流动力学效应是否存在显著差异。
62例年龄在6个月至7岁、接受泌尿生殖系统手术的美国麻醉医师协会（ASA）I - II级儿科患者（12例女性，50例男性）纳入本研究。患者被随机分为两组，每组31例。骶管组在全身 - 区域联合麻醉中接受0.25%左旋布比卡因2 mg·kg⁻¹的骶管阻滞，全身组接受瑞芬太尼平衡全身麻醉。在全身麻醉诱导或骶管阻滞（Tcaud）后5分钟、皮肤切开同时（Tsi）再经过5分钟、皮肤切开后10分钟（T10i）、手术结束时（Tend）测量每组的无创血流动力学参数。Tcaud与Tsi之间的时间为10分钟，根据手术持续时间，在T10i - Tend间隔时间内每15分钟进行一次测量。
皮肤切开时所有测量的血流动力学参数均下降。两组均出现下降，骶管组在皮肤切开时下降，平衡麻醉组在皮肤切开后10分钟下降。这些变化在任何所述结果中均无显著差异；在每个时间点两组之间以及骶管组与基线测量相比均无差异结论：使用经食管多普勒，在骶管左旋布比卡因平衡全身麻醉与瑞芬太尼输注平衡全身麻醉之间未检测到血流动力学参数差异。两种技术均显示出良好的血流动力学稳定性，随着时间推移与基线相比仅有微小变化，除了可能在已有心血管功能不全的患者中，这些变化不太可能具有临床意义。需要在更大人群中进行其他无创监测研究，以更好地了解骶管阻滞对婴儿心输出量和局部血流的影响。
