Ponde Vrushali C, Chavan Dilip N, Desai Ankit P, Gursale Anuya A, Bedekar Vinit V, Puranik Kiran A
Children Anaesthesia Services, Department of Anaesthesia, Mumbai, Maharashtra, India.
J Anaesthesiol Clin Pharmacol. 2020 Jul-Sep;36(3):386-390. doi: 10.4103/joacp.JOACP_200_17. Epub 2020 Sep 28.
Current concerns related to the anesthetic neurotoxicity have brought a renewed interest in regional anesthesia. Regional anesthesia reduces the need for opioids and inhalational anesthetics. The immaturity of the neonatal and infant nervous system may render them more prone to neurotoxicity. We describe our technique of anesthesia, which minimizes the exposure to general anesthetics and reduces airway instrumentation because the operability is rendered by the regional block.
This was a retrospective case series of neonates and infants undergoing common surface surgeries. We describe our technique of anesthesia where regional blocks are the mainstay. We also put up the data pertaining to block effectiveness, technique, end-tidal sevoflurane concentration and complications.
One thousand patients, including neonates and infants, received central and peripheral nerve blockade. The failure rate in upper extremity blocks 0% without complications. 86.12% were given under ultrasonography (USG) guidance and 13.89% were given with peripheral nerve stimulation. The failure rate of sciatic block single shot and continuous was 0%. 92.53% were given with USG guidance while 7.46% received sciatic with nerve stimulation technique. Failure rate of caudal epidural block was 0. 78% requiring a rescue analgesic, 1.4% had blood in the needle. Out of the caudals, 33.33% were done with USG guidance and 66.67% blocks were given with traditional techniques. Out of the 322 penile + ring blocks given by traditional method, 1 block failed requiring rescue analgesics. The mean sevoflurane concentration was 1.2 +/- 0.32.
It is feasible to conduct surface surgeries in the most vulnerable population such as neonates and infants under regional anesthesia without intubation and airway instrumentation.
目前对麻醉性神经毒性的关注使人们对区域麻醉重新产生兴趣。区域麻醉减少了对阿片类药物和吸入性麻醉剂的需求。新生儿和婴儿的神经系统不成熟可能使他们更容易受到神经毒性的影响。我们描述了我们的麻醉技术，该技术将全身麻醉剂的暴露降至最低，并减少气道操作，因为区域阻滞提供了可操作性。
这是一项对接受常见体表手术的新生儿和婴儿的回顾性病例系列研究。我们描述了以区域阻滞为主要手段的麻醉技术。我们还列出了与阻滞效果、技术、呼气末七氟醚浓度和并发症相关的数据。
1000例包括新生儿和婴儿在内的患者接受了中枢和周围神经阻滞。上肢阻滞的失败率为0%，无并发症。86.12%在超声（USG）引导下进行，13.89%采用周围神经刺激进行。坐骨神经单次注射和连续阻滞的失败率为0%。92.53%在USG引导下进行，7.46%采用神经刺激技术进行坐骨神经阻滞。骶管硬膜外阻滞的失败率为0。78%需要使用急救镇痛药，1.4%穿刺针有回血。在骶管阻滞中，33.33%在USG引导下进行，66.67%采用传统技术进行阻滞。在采用传统方法进行的322例阴茎+环状阻滞中，1例失败，需要急救镇痛药。七氟醚平均浓度为1.2±0.32。
在区域麻醉下，对新生儿和婴儿等最脆弱人群进行体表手术，无需插管和气道操作是可行的。
