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

• Published in: Anesthesia and analgesia Vol. 98; no. 4; pp. 948 - 955
• Main Authors: Raux, Olivier, Rochette, Alain, Morau, Estelle, Dadure, Christophe, Vergnes, Christine, Capdevila, Xavier
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.04.2004; Lippincott
• Subjects: Algorithms; Anesthesia; Anesthesia, Epidural; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local; Biological and medical sciences; Cardiac Output - drug effects; Child, Preschool; Double-Blind Method; Echocardiography, Transesophageal; Epinephrine - pharmacology; Female; Hemodynamics - drug effects; Humans; Infant; Male; Medical sciences; Nerve Block; Prospective Studies; Vasoconstrictor Agents - pharmacology; Human; Randomization; Extradural administration; Double blind study; Anesthesia; Block; Cardiac output; Child
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ANE.0000108133.63310.AF

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.