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Epidural analgesia for major neonatal surgery
Author(s) -
Bösenberg Adrian T
Publication year - 1998
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1046/j.1460-9592.1998.00322.x
Subject(s) - medicine , anesthesia , bradycardia , lumbar , convulsion , surgery , catheter , continuous infusion , epilepsy , heart rate , psychiatry , blood pressure , radiology
Safe effective analgesia for neonates undergoing major surgery remains a challenge particularly in institutions where resources are limited. The experience in the use of epidural analgesia in 240 neonates weighing between 0.9–5.8 kg body weight (lumbar n =211, thoracic n =29) is reviewed. Dural puncture ( n =1), convulsion(r)( n =1) and intravascular migration of catheter ( n =1) were the only complications. In all cases effective analgesia was established intraoperatively. Postoperatively analgesia was maintained by intermittent ‘top‐ups’ ( n =170) and continuous infusion ( n =10). Skin epidural distance ranged between 3 and 12 mm (mean 6.0±1.7 mm) and did not correlate with the patients’ weight. Patients remained haemodynamically stable except occasional bradycardia below 100 ( n =15) which was successfully managed with anticholinergics. The potential risks and benefits of epidural analgesia in this age group are discussed and arguments for intermittent ‘top‐up’ doses rather than continuous infusions presented.