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PEDIATRIC ANESTHESIA

The Hemodynamic Effects of Pediatric Caudal Anesthesia Assessed by Esophageal Doppler

Eric Larousse, MD^*, Karim Asehnoune, MD^*, Bruno Dartayet, MD^*, Pierre Albaladejo, MD^*, Anne-Marie Dubousset, MD^*, Frédéric Gauthier, MD, and Dan Benhamou, MD^*

*Department of Anesthesiology and Critical Care Medicine and Department of Pediatric Surgery, Centre hospitalo-universitaire du Kremlin Bicêtre, France

Address correspondence and reprint requests to Eric Larousse, MD, Department of Anesthesia and Intensive Care Medicine, Hôpital Kremlin Bicêtre, 78, rue du Général Leclerc, F-94275 Kremlin Bicêtre, France. Address e-mail to larousse.eric{at}wanadoo.fr

Pediatric caudal anesthesia is an effective method with an infrequent complication rate. However, little is known about its cardiovascular consequences. Transesophageal Doppler, a noninvasive method, provides the opportunity for a reappraisal of the hemodynamic effects of this technique. After parental informed consent, we studied 10 children aged 2 mo to 5 yr who were scheduled for lower abdominal surgery. General anesthesia was induced using sevoflurane and was followed by the insertion of a transesophageal Doppler probe. Caudal anesthesia was performed using 1 mL/kg of 0.25% bupivacaine with 1/200,000 epinephrine. Hemodynamic variables were collected before and after caudal anesthesia. No complications arose during insertion of the probe. The mean time between the two sets of measurements was 15 min. Heart rate, systolic, diastolic, and mean arterial blood pressures were not modified by caudal anesthesia. Descending aortic blood flow increased significantly from 1.14 to 1.92 L/min. (P = 0.0002). Aortic ejection volume increased from 8.5 to 14.5 mL (P = 0.0002). Aortic vascular resistances decreased from 6279 to 3901 dynes · s^-1 · m^-5 (P = 0.005). Caudal anesthesia did not affect heart rate and mean arterial blood pressure but induced a significant increase in descending aortic blood flow.

IMPLICATIONS: Although pediatric caudal anesthesia does not alter heart rate nor arterial blood pressure, significant changes occur in regional blood flow distribution. Descending aortic blood flow increases significantly after caudal anesthesia, whereas lower body vascular resistances decrease.

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