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专家关于新生儿和婴儿区域阻滞的提示。

Expert's tips on regional blocks in neonates and infants.

作者信息

Ponde Vrushali Chandrashekhar, Rath Amrita, Singh Neha

机构信息

Department of Anaesthesiology, Surya Children Hospital, Children Anaesthesia Services, Mumbai, India.

Department of Anaesthesiology, Banaras Hindu University, Institute of Medical Sciences, Varanasi, India.

出版信息

Anesth Pain Med (Seoul). 2024 Oct;19(Suppl 1):S73-S86. doi: 10.17085/apm.23164. Epub 2024 Jul 29.

Abstract

Pediatric regional anesthesia (RA) has emerged as a rapidly advancing dimension within pediatric anesthesia, demanding a continual commitment to knowledge acquisition. This review underscores the contemporary significance of this specialty, focusing on its application in neonates and infants. The primary objective of RA is to address perioperative pain effectively while preserving the delicate physiological balance, thereby enhancing overall patient care. This review explores the advantages offered by RA in this age group. Furthermore, conventional, and recently introduced techniques of RA are examined by exploring the advantages and disadvantages of these methods. The aim is to provide clinicians with a nuanced understanding of their applicability in different clinical scenarios. Additionally, the review elucidates the unique considerations associated with pediatric RA, acknowledging pediatric patients' distinctive anatomical and physiological characteristics. The exceptional cases of congenital anomalies and their implications for the choice of RA are considered. An aspect of the review is its focus on dosages of local anesthetics and the volumes required for various blocks in neonates and infants. The dosages for continuous infusion and practical issues with infusions are considered. Complications due to RA are described with their prevention and treatment. The review offers pragmatic insights into the selection criteria for various regional blocks, aiding anesthesiologists in making informed decisions tailored to individual patient needs.

摘要

小儿区域麻醉(RA)已成为小儿麻醉领域中快速发展的一个方面,需要持续不断地致力于知识获取。本综述强调了该专业的当代重要性,重点关注其在新生儿和婴儿中的应用。区域麻醉的主要目标是在维持脆弱的生理平衡的同时有效解决围手术期疼痛,从而提高整体患者护理水平。本综述探讨了区域麻醉在这个年龄组中的优势。此外,通过探究这些方法的优缺点,对传统的和最近引入的区域麻醉技术进行了研究。目的是让临床医生对其在不同临床场景中的适用性有细致入微的了解。此外,该综述阐明了与小儿区域麻醉相关的独特考量因素,承认小儿患者独特的解剖学和生理学特征。考虑了先天性异常的特殊情况及其对区域麻醉选择的影响。该综述的一个方面是关注局部麻醉药的剂量以及新生儿和婴儿各种阻滞所需的容量。考虑了持续输注的剂量以及输注的实际问题。描述了区域麻醉引起的并发症及其预防和治疗方法。该综述为各种区域阻滞的选择标准提供了实用的见解,有助于麻醉医生根据个体患者需求做出明智的决策。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f327/11566559/f0afedb0893c/apm-23164f1.jpg

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