小儿脊髓麻醉中基于年龄的局部麻醉药剂量：一种新配方的评估——印度患者的一项初步研究

Age-based Local Anesthetic Dosing in Pediatric Spinal Anesthesia: Evaluation of a New Formula - A Pilot Study in Indian Patients.

作者信息

Parthasarathy S, Senthilkumar T

机构信息

Department of Anesthesiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India.

出版信息

Anesth Essays Res. 2017 Jul-Sep;11(3):627-629. doi: 10.4103/aer.AER_246_16.

DOI:10.4103/aer.AER_246_16

PMID:28928560

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5594779/

Abstract

BACKGROUND

Spinal anesthesia is a safe alternative to general anesthesia and often the anesthetic technique of choice in many lower abdominal and lower limb surgeries in children. As the vertebral column and spinal cord grows variedly with age and not weight, we planned to administer an age-based dosing schedule of hyperbaric bupivacaine in the intra-thecal space in select infra umbilical surgeries in children. The aim was to find out the efficacy and complications associated with this dosage.

METHODOLOGY

Twenty-five pediatric patients between 2 and 12 years, posted for elective infra umbilical surgeries were given a sedation as a combination of effective doses of pentazocine, midazolam, and atropine. In all those patients, spinal anesthesia was administered at a dose of age/5 of hyperbaric bupivacaine. The number of attempts, the onset of blockade, the mean sensory level, and the duration of anesthesia were noted. Any other complications were also noted.

RESULTS

The mean and standard deviation of age is 7.68 ± 2.49 years. Intra-thecal anesthesia was administered successfully in the first attempt in 88% of cases whereas the remaining needed the second attempt. Three patients needed intravenous ketamine of 0.25 mg/kg additionally for preoperative sedation. The sensory level was between T6 and T10 with a mean of T8.5. There were no intra-operative complications. In all patients, surgery was finished within the duration of anesthesia of approximately 60 min. There was no conversion to general anesthesia in any case, but a three patients required dose of 0.25 mg/kg of intravenous ketamine as a calming dose.

CONCLUSION

Administration of age-based local anesthetic dosing of hyperbaric bupivacaine in the intra-thecal space by utilizing a new formula of age/5 (Partha formula) is successful in a pilot study in Indian children for infra-umbilical surgeries. There were no observed complications.

摘要

背景

脊髓麻醉是全身麻醉的一种安全替代方法，在许多儿童下腹部和下肢手术中常常是首选的麻醉技术。由于脊柱和脊髓随年龄而非体重变化生长，我们计划在儿童择期脐下手术的鞘内间隙给予基于年龄的高压布比卡因给药方案。目的是找出该剂量的疗效和并发症。

方法

25例年龄在2至12岁之间、计划进行择期脐下手术的儿科患者，给予有效剂量的喷他佐辛、咪达唑仑和阿托品联合镇静。在所有这些患者中，以高压布比卡因年龄/5的剂量进行脊髓麻醉。记录穿刺次数、阻滞起效时间、平均感觉平面和麻醉持续时间。还记录任何其他并发症。

结果

年龄的平均值和标准差为7.68±2.49岁。88%的病例首次尝试鞘内麻醉成功，其余患者需要第二次尝试。3例患者术前镇静还额外需要0.25mg/kg静脉注射氯胺酮。感觉平面在T6至T10之间，平均为T8.5。术中无并发症。所有患者的手术均在约60分钟的麻醉时间内完成。无一例转为全身麻醉，但有3例患者需要0.25mg/kg静脉注射氯胺酮作为镇静剂量。