Regional anaesthesia in children
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Regional anaesthesia techniques such as caudal anaesthesia can be used in children for a variety of purposes including as an adjunct to general anaesthesia and for postoperative pain management. Caudal anaesthesia specifically involves injecting local anaesthetic in the caudal space and is commonly used for procedures like hernia repairs and lower extremity surgery due to being simple, easy to perform, and associated with few complications when done correctly. Proper patient positioning, identification of anatomical landmarks, and use of ultrasound can help ensure safe and effective delivery of caudal anaesthesia in children.
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Regional anaesthesia in Pediatrics
Regional anesthesia can be safely used in pediatric cases. While initially there was concern over its use in children, several large studies proved its efficacy and safety. Proper technique must account for anatomical differences in children, such as higher spinal levels and more flexible vertebrae. With the correct dose and placement of local anesthetic, regional anesthesia provides effective pain relief for pediatric surgeries and procedures.
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Spinal anesthesia can be used as a primary anesthetic technique in children, especially for former preterm infants to reduce postoperative apnea risk compared to general anesthesia. Key differences in pediatric spinal anatomy and physiology require lower needle insertion points and higher local anesthetic doses in children. Spinal anesthesia provides effective pain control and fewer cardiovascular and respiratory complications than general anesthesia for many pediatric surgeries under 90 minutes. Complications are generally minor when performed carefully according to age-specific anatomical considerations and monitoring.
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Regional anaesthesia in Pediatrics
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1. Anatomical abnormalities of the spine like thickened ligaments or spinal deformities can make proper needle placement difficult.
2. Technical errors like using too small of a needle, improper patient positioning, or inexperience of the practitioner performing the block can lead to failure.
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1. Tonsillectomy requires maintaining deep general anesthesia to prevent reflex responses during the procedure while allowing for rapid recovery of airway reflexes.
2. Intubation is usually done under deep inhalational or muscle relaxant anesthesia to prevent bucking, and the tube is secured to prevent aspiration of blood or secretions.
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Daycare surgery involves operations where the patient is discharged on the same day. General anaesthesia is commonly used, while central neuraxial blocks are discouraged due to delayed discharge from motor block. Local and plexus blocks are good options. Anaesthetic goals include smooth onset, adequate intraoperative analgesia/amnesia, and rapid recovery. Common daycare surgeries include hernia repair, hemorrhoidectomy, laparoscopic procedures, otoplasty, and cystoscopy. Monitored anaesthesia care involves anaesthesiologist oversight during planned procedures. Non-operating room anaesthesia presents challenges due to unfamiliar environments but can be addressed through thorough patient evaluation, appropriate monitoring, and careful planning for procedures such as cardiac catheter
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Delayed recovery from anesthesia can have multiple contributing factors and causes. It is important to consider potential drug interactions, metabolic abnormalities, and organic causes that may cause prolonged unconsciousness and have serious health implications. Signs and symptoms of metabolic issues may not present normally in an anesthetized patient. The Glasgow Coma Scale provides an objective measure of conscious state regardless of cause.
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3) Left ventricular hypertrophy and diastolic dysfunction from long-standing hypertension increase perioperative risk and require careful fluid management during surgery.
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This document discusses regional anesthesia techniques in pediatrics. It provides a brief history of regional anesthesia in children and outlines key advantages like reduced stress response and improved outcomes. It notes important differences between children and adults physiologically, psychologically, pharmacologically and anatomically that are important to consider. The document then describes various regional anesthesia procedures that can be used in children like caudal blocks, epidurals and peripheral nerve blocks. It emphasizes the importance of skill and proper equipment when performing regional techniques in children.
ANESTHESIA MANAGEMENT OF CLEFT LIP & PALATE
ANESTHESIA MANAGEMENT
CASE SCENARIO
PROVISIONAL DIAGNOSIS
ANESTHETIC MANAGEMENT
DISCUSSION
ANESTHETIC CONSIDERATIONS
PERIOPERATIVE MANAGEMENT
CONCLUSION
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Dexmedetomidine is a selective alpha-2 adrenoceptor agonist approved by the FDA for short-term sedation. It has sedative, anxiolytic, and analgesic properties. Dexmedetomidine has advantages over other sedatives in the ICU as it causes less respiratory depression, easier arousability, and lower incidence of delirium. Its pharmacokinetics are nonlinear and it undergoes extensive hepatic metabolism. Dexmedetomidine is also used for sedation during procedures, as an adjuvant for anesthesia and analgesia, and for neurological protection during surgery.
Failed spinal-anesthesia-mgmc
Failed spinal anesthesia can occur for several reasons:
1. Anatomical abnormalities of the spine like thickened ligaments or spinal deformities can make proper needle placement difficult.
2. Technical errors like using too small of a needle, improper patient positioning, or inexperience of the practitioner performing the block can lead to failure.
3. Injection issues such as injecting the anesthetic outside of the subarachnoid space, using the wrong drug or dose, bloody taps, or repeated autoclaving altering the drug properties may cause failure. Prevention through proper patient assessment, technique, and management of failures is important to minimize risks.
Anesthesia For Congenital Diaphragmatic Hernia
This document discusses congenital diaphragmatic hernia (CDH), a birth defect where organs protrude into the chest cavity due to a hole in the diaphragm. It covers the embryology, pathophysiology, diagnosis, and management of CDH. Surgical repair is the only treatment, but stabilization of the patient's respiratory and general status is needed first. Extracorporeal membrane oxygenation (ECMO) has improved survival for CDH. Long-term follow up is also important due to potential complications. A regional anesthesia method without opioids allowed early operating room extubation for CDH repair in one study.
Anaesthesia for posterior fossa surgery
The document discusses the posterior fossa, including its boundaries, contents, blood supply, clinical presentation of lesions, and considerations for anesthesia. The posterior fossa is bounded anteriorly by the clivus and petrous bone, posteriorly by the occipital bone, and laterally by the temporal bone. It contains the cerebellar hemispheres, brainstem, and cranial nerves III-XII. Lesions can cause a variety of signs and symptoms depending on location, including ataxia, nystagmus, limb weakness, and cranial nerve deficits. Anesthesia for posterior fossa surgery requires careful monitoring and positioning to maintain stability while allowing surgical access.
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This document discusses the history, techniques, and physiology of controlled hypotensive anesthesia. It began in 1917 to provide a bloodless surgical field for neurosurgery. Various techniques were developed over time using drugs like nitroprusside and anesthetics to safely lower blood pressure. Key aspects include carefully monitoring vital organ perfusion and using positioning, ventilation, and fluids to potentiate the effects while avoiding dangerous drops in blood flow to the brain, heart, kidneys and other organs.
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This document discusses different oxygen therapy techniques including conventional oxygen therapy and high flow nasal cannula (HFNC) oxygen therapy. It provides details on:
- How HFNC works by using an air/oxygen blender to deliver high flows of humidified oxygen at variable concentrations.
- The physiologic effects of HFNC including improved oxygen delivery to the alveoli and prevention of adverse effects from lack of humidification.
- Techniques called THRIVE and STRIVE-Hi that use HFNC to provide apneic oxygenation and tubeless anesthesia, extending the time available to secure an airway without risk of hypoxemia.
Controlled hypotension in anesthesia
This document provides an outline and overview of controlled hypotension during anesthesia. It begins with definitions and a brief history of controlled hypotension. It then discusses the principles and techniques of inducing hypotension, including pharmacological agents like sodium nitroprusside, nitroglycerin, beta blockers, and calcium channel blockers. It also covers non-pharmacological techniques like positioning and acute normovolemic hemodilution. Monitoring, fluid management, and postoperative care are also outlined. The document concludes with sample multiple choice questions related to controlled hypotension.
Rapid sequence spinal anesthesia (RSS).pptx
Rapid sequence spinal anesthesia (RSS) is a technique used for urgent cesarean sections that requires effective coordination between medical staff. Segmental spinal anesthesia involves puncturing the spinal cord at higher thoracic levels using lower doses of local anesthetic, allowing selective blockade of dermatomes needed for surgery. This technique provides hemodynamic stability, less motor blockade, and faster recovery compared to conventional spinal anesthesia. Careful performance of segmental spinal anesthesia can establish it as a routine procedure for day surgery.
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epidural anesthesia
This document discusses epidural anesthesia. Some key points:
- Epidural anesthesia allows for placement of a continuous catheter, which is useful for cases of unpredictable duration, prolonged postoperative analgesia, chronic pain control, and obstetric analgesia/anesthesia.
- Local anesthetics injected into the epidural space spread horizontally to nearby dermatomes and vertically in a preferentially cephalad direction.
- Factors affecting the level and spread of an epidural block include injection site, dose, volume, concentration, position, age, and speed of injection. Increasing dose and volume increases spread, while concentration mostly affects density.
- Onset is usually within 5 minutes, and peak
ESP block
Erector spinae plane block is a relatively novel approach to pain management for a variety of surgical procedures. ESP block is a challenging anesthesia and analgesia technique that needs more research.
Tonsillectomy - anaesthetic consideration
1. Tonsillectomy requires maintaining deep general anesthesia to prevent reflex responses during the procedure while allowing for rapid recovery of airway reflexes.
2. Intubation is usually done under deep inhalational or muscle relaxant anesthesia to prevent bucking, and the tube is secured to prevent aspiration of blood or secretions.
3. During the procedure, inhaled anesthetics with opioids or muscle relaxants are used to maintain adequate depth while monitoring for blood loss or airway issues.
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Regional anaesthesia in children
- 1. REGIONAL ANAESTHESIA IN CHILDREN (Caudal Anaesthesia) BY – Dr. A. Shreeram
- 2. INTRODUCTION • Used as adjunct to general anaesthesia. • In multimodal post operative pain management. • Generally used drug : Levobupivacain & Ropivacain. • Single shot technique used for minor procedure. • Continuous peripheral nerve block is recent advancement.
- 6. INDICATION 1. As an adjunct to GA. 2. Perioperative analgesia. 3. Nonsurgical pain. Eg.- Herpes zoster, AIDS, Sickle cell crisis, cutaneous lesion etc. 4. Chronic pain relief. Eg.- phantom limb, complex regional pain syndrome, chronic dislocated hip, pain of cancer etc. 5. Non analgesic indication. Eg.- vascular insufficiency etc.
- 7. CONTRAINDICATION 1. Severe coagulation defect. 2. Severe infection/sepsis. 3. Raised ICT. 4. True allergy to LA. 5. Chemotherapy. 6. Uncorrected hypovolemia. 7. Cutaneous lesion at the injection site. 8. At risk for compartment syndrome. 9. Hemoglobinopathies. 10. Bone & joint deformities. 11. Pre-existing neurological disorders.
- 8. BLOCK TECHNIQUES 1. Single Shot. 2. Single Shot + LA & Adjuncts. 3. Catheter technique.
- 9. NEEDLES • Epidural : Tuohy Needle : 22-17 G : 50-90 cm. • Caudal : Crawford Needle : short bevelled. • Spinal : Queincke Needle : 24-25 G : 30/50/100mm
- 10. ANATOMICAL IDENTIFICATION 1. Manual approach : caudal, epidural & spinal. 2. Nerve stimulator : As an adjunct to manual & ultrasound guided block. 3. Ultrasound guided : axillary block, femoral block, fascia iliaca compartment block, caudal block, ilioinguinal block, paraumbilical block.
- 11. CAUDAL ANAESTHESIAA type of neuraxial block
- 12. INTRODUCTION • Most commonly used technique of epidural blockade. • Simple & easy. • Very few complications. • Decreases stress hormones to surgery. • Failure rate 3-11%
- 14. INDICATION • Inguinal hernia repair. • Urinary & digestive tract surgery. • Orthopaedic procedure on pelvic girdle & lower extremities.
- 15. CONTRAINDICATION • Major malformation of sacrum. • Meningitis. • Intracranial hypertension.
- 16. TECHNIQUE
- 17. TECHNIQUE
- 18. SONOANATOMY
- 19. USG TECHNIQUE
- 20. DRUGS • Volume (Armitage Prescription): 0.5ml/kg : All sacral dermatomes. 1ml/kg : All sacral & lumbar dermatomes. 1.25ml/kg : Up to mid thoracic level.
- 21. COMPLICATION • Infrequent. • Usually minor. • Dural puncture. • Cardiovascular collapse. • Respiratory arrest.
- 22. Reference : Miller’s Anaesthesia