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PEDIATRIC ANESTHESIA

The Effects of Spread of Block and Adrenaline on Cardiac Output After Epidural Anesthesia in Young Children: A Randomized, Double-Blind, Prospective Study

Olivier Raux, MD^*, Alain Rochette, MD^*, Estelle Morau, MD^*, Christophe Dadure, MD^*, Christine Vergnes, MD, and Xavier Capdevila, PhD^*

From the Departments of *Anesthesiology and Medical Information, CHU Montpellier, France

Address correspondence and reprint requests to Olivier Raux, MD, Département d’Anesthésie Réanimation A, Hôpital Lapeyronie, 371, Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France. Address email to o-raux{at}chu-montpellier.fr

Epidural anesthesia is considered to be without significant hemodynamic consequence in young children. However, conversely to adults, few studies have investigated cardiac output. Using transesophageal Doppler monitoring of cardiac output, we prospectively investigated hemodynamic alterations in 48 children (median age, 22.5 mo) receiving sevoflurane general anesthesia combined with caudal or thoracolumbar epidural anesthesia. They were randomly assigned to receive 0.8 mL/kg of plain local anesthetic mixture (lidocaine 1% + bupivacaine 0.25% (50/50) + 1 µg/mL of fentanyl) or 1 mL/kg of the same mixture with 5 µg/mL of adrenaline. No significant hemodynamic alteration was elicited in caudal and thoracolumbar groups receiving the plain mixture except a moderate decrease in heart rate. Conversely, a mixture with adrenaline added provoked a significant decrease in mean arterial blood pressure by 14% and 17%, in systemic vascular resistance by 24% and 40%, and an increase in cardiac output by 20% and 34% in caudal and thoracolumbar groups, respectively. The adrenaline effect was greater by the thoracolumbar than the caudal approach. In young children, epidural anesthesia induces an increase in cardiac output only when adrenaline is added to local anesthetics, probably through its systemic absorption from the epidural space.

IMPLICATIONS: Epidural anesthesia may induce significant hemodynamic changes, well documented in adults. Using noninvasive hemodynamic monitoring in children, we reported an increase in cardiac output and a decrease in arterial blood pressure only when epinephrine was added to epidurally-injected local anesthetics.

This article has been cited by other articles:

				A. Monsel, A. Salvat-Toussaint, P. Durand, V. Haas, C. Baujard, P. Rouleau, S. El Aouadi, D. Benhamou, and K. Asehnoune The Transesophageal Doppler and Hemodynamic Effects of Epidural Anesthesia in Infants Anesthetized with Sevoflurane and Sufentanil Anesth. Analg., July 1, 2007; 105(1): 46 - 50. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999