This document discusses differences in pediatric neuraxial anesthesia compared to adults. It notes that neonates have higher cerebrospinal fluid volumes relative to their weight, requiring higher local anesthetic doses. Spinal anesthesia is commonly used in neonates to reduce apnea after preterm birth. Complications of spinal and caudal anesthesia include post dural puncture headache, urinary retention, and neurological effects. Epidural anesthesia techniques must account for looser ligaments and spinal anatomy in children.

1. Michael de la Peña Martínez
Universidad de Cartagena
Anestesiología y Reanimación
2012
Anestesia Neuroaxial en
Pediatría

2. Neuraxial anesthesia

3. Diferencias Anatómicas
Neuraxial anesthesia

4. Diferencias Anatómicas
Neuraxial anesthesia
Figure 42-5. Distance from the skin to the subarachnoid space as a function of age.
(Data from Bonadio WA, Smith DS, Metrou M, et al: Estimating lumbar puncture depth
in children. N Engl J Med 1988; 319:952-953; Kosaka Y, Sato K, Kawaguchi R:
[Distance from the skin to the epidural space in children.] Masui 1974; 23:874-875; Lau
HP: [The distance from the skin to the epidural space in a Chinese patient population.]
Ma Tsui Hsueh Tsa Chi 1989; 27:261-264.)

5. Diferencias Anatómicas
Neuraxial anesthesia
 LCR Neonato 4ml/kg / Adulto 2ml/kg
LCR en ESA ~ 50% / 25%
Figure 42-6. Approximate volume of cerebrospinal fl
uid (CSF) relative to weight and age. Note that
preterm and full-term infants have a much greater
CSF volume relative to weight than a child or adult;
this may account in part for the increased dose
(mg/kg) of local anesthetic required in infants to
produce a successful subarachnoid block

6. Neuraxial anesthesia
S1 Neonatos
L5 Infantes
L4-L5 Niños
L4 adolecentes
L3-L4 Adultos
Diferencias Anatómicas

7. Neuraxial anesthesia

8. Anestesia Espinal
 1901
 Reducir la apnea POP en prematuros y ex
prematuros
Neuraxial anesthesia

9. Anestesia Espinal
 Neonato: Aguja espinal 22G de 1/2 pulgada
 > 2 años
 Dosis (Hasta 10x dosis proporcional)
 Bupivacaina isobárica/Hiperbarica
< 5Kg: 0.5-0.6mg/kg
5-15Kg: 0.4mg/kg
> 15kg: 0.3mg/kg
Neuraxial anesthesia

10. Neuraxial anesthesia

11. Anestesia Espinal: Complicaciones
 CPPD
 10 – 50% en Px entre 10 - 18años
 Cafeína 300-500mg 1 o 2 veces/día
 LIV, reposo, analgésicos orales
 Parche de sangre: 0.3ml/kg (> 48h)
 Anestesia Espinal Total
 No cambios hemodinámicos en < 5 años
Neuraxial anesthesia

12. Neuraxial anesthesia

13. Neuraxial anesthesia

14. Neuraxial anesthesia
Bupi Levo
0.175% 0.2%
< 5a: 10-13h
6-10a: 2-3h
> 10a: 1-2h

15. Anestesia Caudal: Complicaciones
 Aplicación intravascular, Espinal o Medula
ósea sacra
 > Incidencia de colonización (20%)
 Retención urinaria, debilidad muscular, prurito,
o náuseas y vómitos
Neuraxial anesthesia

16. Anestesia Caudal: Contraindicaciones
 Quiste pilonidal
 Marca superficial anormal a nivel sacro
 Meningitis
 Mielomeningocele
 Neuropatía degenerativa progresiva
Neuraxial anesthesia

17. Neuraxial anesthesia

18. Anestesia Epidural
Neuraxial anesthesia
Ligamentos mas laxos
Angulación de aguja
Medula ocupa la
mayoría del espaacio

19. Anestesia Epidural
 Bolo 0.3-0.5ml/kg
 Colonización 4%
Neuraxial anesthesia