ORIGINAL ARTICLE   

Minerva Anestesiologica 2022 July-August;88(7-8):564-72

DOI: 10.23736/S0375-9393.22.15904-3

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Ultrasound-guided epidural anesthesia and sedation for open transvesical Cohen ureteric reimplantation surgery in 20 consecutive children: a prospective case series and proof-of-concept study

Philipp OPFERMANN ¹, Markus ZADRAZIL ¹, Ursula TONNHOFER ², Martin METZELDER ², Peter MARHOFER ³, Werner SCHMID ¹ ✉

¹ Department of Anesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria; ² Division of Pediatric Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; ³ Department of Anesthesiology and Intensive Care Medicine, Speising Orthopedic Hospital, Vienna, Austria

BACKGROUND: Epidural anesthesia is usually combined with general anesthesia (GA) for children undergoing sub-umbilical surgery and GA in children is associated with a potential for respiratory events. Aiming to reduce airway manipulation and the use of GA drugs, we designed a study of transvesical Cohen ureteteric reimplantion under epidural anesthesia in sedated, spontaneously breathing children.
METHODS: We enrolled 20 children (3-83 months, 6.3-25.0 kg) scheduled for open transvesical abdominal surgery with Pfannenstiel incision. Sedation was followed by ultrasound-guided epidural anesthesia. Increases in heart rate by >15% and or patient movements upon skin incision were rated as block deficiencies. Intubation equipment for advanced airway management was kept on standby. The primary study endpoint was successful blockade, meaning that no sequential airway management was required for the spontaneous breathing patients during surgery. Secondary endpoints included any use of fentanyl/propofol intraoperatively and of postoperative analgesics in the recovery room.
RESULTS: All 20 blocks were successful, with no block deficiencies upon skin incision, no need for sequential airway management, and stable SpO2 levels (97-100%). Surgery took a median of 120.5 minutes (IQR: 89.3-136.5) and included one bolus of fentanyl in one patient 120 minutes into a protracted operation. No more systemic analgesia had to be provided in the recovery room.
CONCLUSIONS: Sedation and epidural anesthesia emerged as a useful alternative to GA from our consecutive case series.

KEY WORDS: Anesthesia; Ultrasonography; Ropivacaine; Infant