Paediatric anaesthesia
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The pediatric epidural is an accepted method of advanced analgesia in children. Newer techniques have now superseded pediatric epidural analgesia (PEA), being as effective and safer, especially with the advances in ultrasonography. PEA is, however, still an important technique to master and employ, and it may be that the indications for this mode of analgesia have now become more defined.
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Regional anesthesia in children has reached in the last decades a widespread approval and today is a valid and effective technique used in the daily activity in many pediatric centres. Data from surveys and studies show the very low rate of complications and suggest that the use of regional techniques in children is at least as safe as general anesthesia alone. Despite these evidences there are aspects still creating discussions on the best approach to avoid or prevent risks and on the way to make this techniques more and more reliable and safe. Compartment syndrome, test dose, loss-of-resistance technique and blocks performed under general anesthesia are examples of, sometimes, never-ending stories; this review without the presumption to solve every problem shows the more recent data to offer, if possible, the best updated-answer on these topics.
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Paediatric anaesthesia · Jan 2012
ReviewQuality assurance and improvement: the Pediatric Regional Anesthesia Network.
Quality assurance and improvement (QA/QI) is a critical activity in medicine. The use of large-scale collaborative databases is increasingly essential to obtain enough reports with which to establish standards of practice and define the incidence of complications and risk/benefit ratios for rare events. ⋯ The pediatric regional anesthesia network (PRAN) is such a project. The first data cohort is currently being analyzed and offers insight into how such data can be used to detect trends in adverse events and improve care.
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The use of regional anesthesia is increasingly common in pediatric practice. This review reports the complications and risks in pediatric regional anesthesia. ⋯ However, the different studies have shown that regional anesthesia, when performed properly, carried a very low risk of morbidity in appropriately selected infants and children. In addition, the use of ultrasound-guided peripheral nerve blockade has shown some promise toward increasing the safety profile of these already safe techniques.
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Paediatric anaesthesia · Jan 2012
ReviewToxicity of local anesthetic drugs: a pediatric perspective.
The main mechanism of action of local anesthetics (LA) is to block sodium channels, thereby interrupting the propagation of nerve impulses. However, this action not only is localized to the sodium channels of nerve tissues involved with pain transmission but will have its effect on any tissue containing sodium channels. ⋯ The two most important tissues associated with systemic toxicity of LA are the central nervous and the cardiovascular systems, which may lead to seizures, tachyarrhythmias, and ultimately death from apnea and cardiovascular collapse. The aim of this communication is to elucidate some issues that are associated with toxicity of LA and its treatment in the pediatric population.