Pediyatrik kaudal blok deneyimlerimiz
Amaç: Kaudal blok pediyatrik hasta grubunda umbilikus altı cerrahilerde intraoperatif anestezi ve postoperatif analjezi amacıyla sık tercih edilen yöntemlerden biridir. Çalışmamızın amacı; kliniğimizde kaudal blok uygulamalarımız sırasında sık kullanılan lokal anestezik ve adjuvan ilaçları tespit etmek, uygulamaya bağlı yan etki ve komplikasyonları değerlendirmektir. Yöntem: Haziran 2002-Ocak 2006 tarihleri arasında kliniğimizde kaudal blok uygulanan 363 pediyatrik hastanın perioperatif verileri hasta dosyaları ve anestezi kayıtlarından retrospektif olarak taranarak, hastaların demografik verileri, operasyon türleri, anestezi uygulaması, kullanılan lokal anestezikler, eklenen adjuvan ilaçlar, yan etki ve komplikasyonlar ile postoperatif dönemde hastaların ilk analjezik ihtiyaç süreleri ve kullanılan ek analjezikler kaydedildi. Bulgular: Hastaların 344`ünde %0.25 bupivakain, 13 hastada %0.25 bupivakain ve 50 μg kg-1 midazolam, 6 hastada %0.25 bupivakain ve 2 μg kg-1 neostigmin kullanıldığı görüldü. Kaudal blok için kullanılan lokal anestezik volümünün 0.6 ± 0.1 mL kg-1 olduğu bulundu. Postoperatif dönemde ilk analjezik gereksiniminin 6.5 ± 0.3 saat olduğu saptandı. 19 hastada (%5.2) kaudal bloğun başarısız olduğu bulundu. Toplam 12 hastada bulantı, kusma ve allerjik cilt döküntüsü olduğu bulunurken, ciddi yan etki ve komplikasyonlara rastlanmadı. Sonuç: Umbilikus altı cerrahi geçirecek çocuk hastalarda kaudal epidural blok uygulaması basit ve güvenilir bir anestezi tekniğidir. Uzman ellerde komplikasyon riski oldukça azdır.
Our experiences of paediatric caudal anaesthesia
Objective: Caudal blockage is one of the most common techniques for intraoperative anesthesia and postoperative analgesia in pediatric patients for subumbilical surgery. The purpose of this study is to determine the local anesthetics and adjuvant drugs and to evaluate adverse effects and complications associated with caudal blockage applications in our clinic. Method: The perioperative data of 363 pediatric patients that received caudal blockage between June 2002 and January 2006 were scanned retrospectively and demographic data, operation types, anesthesic applications, local anesthetics, caudal drug volume, additional adjuvant drugs, adverse effects and complications were recorded in addition to the initial analgesic requirements of the patients and supplemental analgesics in the postoperative period Results: Drug administrations were as follows: 0.25% bupivacain was used in 344 patients, 0.25% bupivacain and 50 μg kg-1 midazolam in 13 patients and 0.25% bupivakain and 2 μg kg-1 neostigmin in 6 patients. A local anesthetic volume of 0.6 ± 0.1 mL kg-1 was used for caudal blockage. The initial analgesic requirement was recorded at postoperative 6.5 ± 0.3 hours. The caudal blockage failed in 19 patients (5.2%). While a total of 12 patients reported nausea, vomiting and allergic cutaneous reactions, no serious adverse effects or complications were encountered. Conclusion: The caudal epidural blockage can be easily and safely performed in pediatric patients that will receive subumbilical surgery. The risk of complications is remarkably low with experienced surgeons.
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