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Heart rate response to a caudal block in children anesthetized with sevoflurane after ultrasound confirmation of placement
Author(s) -
Adler Adam C.,
Schwartz Donald A.,
Begley Annemarie,
Friderici Jennifer,
Connelly Neil Roy
Publication year - 2015
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 - 10.1111/pan.12752
Subject(s) - medicine , sevoflurane , heart rate , isoflurane , anesthesia , epinephrine , ultrasound , hemodynamics , blood pressure , radiology
Summary Introduction Previous studies identified decreasing heart rate ( HR ) as a predictor of successful caudal placement in children using halothane and isoflurane. No changes were found in HR in the one study using sevoflurane. We documented HR changes in children following a caudal block during sevoflurane anesthesia utilizing ultrasound to confirm successful caudal placement. Methods Seventy‐one children (1–82 months) were anesthetized with sevoflurane. A caudal block was placed with confirmation by ultrasound. Four aliquots of bupivacaine 0.2% with epinephrine 5 μg·cc −1 were administered for a total volume of 1 cc·kg −1 with HR recorded for 4 min. The outcomes measured were HR changes from the initial baseline and during each 1‐min interval. The age‐related differences in HR were also analyzed. Results Heart rate change from the initial baseline after placing the caudal needle and allowing for equilibration ranged from −10.2% to +8.9% and the HR change from the baseline at the start of each aliquot injection ranged from −9.5% to +8.9%. Most participants ( n = 60, 84.5%) experienced at least one HR reduction over the observation period. For patients <36 months, the HR change ranged from −11 to +12 b·min −1 (mean −0.3); for patients aged ≥36 months, the HR change ranged from −10 to +6 b·min −1 (mean −1.1). Conclusions Heart rate changes following a caudal block in children ≤82 months of age anesthetized with sevoflurane is not a reliable indicator of a successful block. Despite 100% caudal success, many children had no decrease in HR , and in those that did, the decline was of a magnitude indeterminate from beat‐to‐beat variability.