Tobias J D, O'Dell N
AANA J. 1995 Apr;63(2):131-5.
The authors discuss their experience with chloroprocaine for epidural anesthesia in five pediatric patients. While bupivacaine remains the most commonly used local anesthetic in children, recent reports of toxicity document the risks of this agent. The major advantage of chloroprocaine is its rapid metabolism, which thereby minimizes the risks of toxicity, especially in patients with preexisting problems such as young age or underlying hepatic dysfunction, which may limit the metabolism of local anesthetics of the amide class. In three cases, the epidural infusion was combined with the general anesthetic. The cases included hepatic resection, repair of bladder exstrophy, and correction of duodenal atresia. In two other cases, epidural anesthesia was used instead of general anesthesia in a former preterm infant who was undergoing inguinal herniorrhaphy and for lower extremity orthopedic procedures in a child with myotonic dystrophy. In all cases, chloroprocaine was chosen because of preexisting or associated conditions that might increase the risk of bupivacaine toxicity, such as hepatic resection, repeated dosing in a neonate, or the need for higher concentrations of local anesthetic to achieve adequate surgical conditions. Adequate intraoperative conditions were achieved in all five patients. No complications related to chloroprocaine epidural anesthesia were noted. This initial experience suggests that chloroprocaine offers an acceptable alternative to bupivacaine for epidural anesthesia in the pediatric population.
作者讨论了他们在5例儿科患者中使用氯普鲁卡因进行硬膜外麻醉的经验。虽然布比卡因仍是儿童最常用的局部麻醉药，但最近有关毒性的报告记录了该药物的风险。氯普鲁卡因的主要优点是其代谢迅速，从而将毒性风险降至最低，尤其是在存在诸如年龄小或潜在肝功能不全等先前存在问题的患者中，这些问题可能会限制酰胺类局部麻醉药的代谢。在3例病例中，硬膜外输注与全身麻醉联合使用。这些病例包括肝切除术、膀胱外翻修复术和十二指肠闭锁矫正术。在另外2例病例中，硬膜外麻醉用于一名正在接受腹股沟疝修补术的前早产儿，以及一名患有强直性肌营养不良的儿童的下肢骨科手术，而不是全身麻醉。在所有病例中，选择氯普鲁卡因是因为存在可能增加布比卡因毒性风险的先前存在或相关情况，如肝切除术、新生儿重复给药，或需要更高浓度的局部麻醉药以达到足够的手术条件。所有5例患者均实现了充分的术中条件。未观察到与氯普鲁卡因硬膜外麻醉相关的并发症。这一初步经验表明，对于儿科患者的硬膜外麻醉，氯普鲁卡因是布比卡因的一个可接受的替代选择。
