Caudal Anesthesia and Peds Flashcards
(29 cards)
Most commonly used regional block in pediatrics.
Caudal
Contraindications of Caudal blocks
-Pilonidal cyst
-Abnormal superficial landmarks
-Myelomeningocele pts
-Hydrocephalus or intracranial hypertension
-Neuropathies
-Parent non-consent
Needle choices for caudal block
Blunt Caudal needle
Tuohy needle
22 G/20 G angio-catheter
Positioning for caudal block
Lateral position with legs/hips flexed into fetal position – keep an eye on the airway!
Prone position
Ropivacaine 0.2% dosing for caudal block
0.2% 1 ml/kg
The _______ depends upon the needed level of anesthesia.
VOLUME
The _______ depends upon the patient’s weight and the concentration of the local
Dose
The caudal epidural space in children needs a __________ in order to fill the loosely packed space and spread to reach the appropriate ________.
high volume
dermatomes
Sacral level block
0.5-0.75 mL/kg
Lumbar level block
1.0-1.2 mL/kg
Low thoracic block
1.2-1.5 mL/kg
Maximum volume
25 ml
Max dose
3mg/kg
Regional toxicity treatment
Use 20% intralipid solution
Bolus
1.5 mL/kg
repeat 1-2 times if needed
Infusion
0.25 mL/kg/min for 30-60 minutes
Signs of intravascular injection (test dosing)
-HR increase of 10bpm
-BP increase of 15mmHg
-T wave amplitude increase of > 25%
-Bradycardia
Why are children at an increased risk of local toxicity?
Increased CO and increased systemic uptake of agent
Toxicity results in direct________toxicity and _______ toxicity.
-central nervous system
-cardiac
Neurotoxicity symptoms:
HA, somnolence, vertigo, perioral or lingual parathesias, tremors, twitching, shivering or convulsions
Cardiac toxicity:
LA prevents the fast inward sodium channels in the myocardium from opening.
Dysrhythmias, conduction block, widening QRS, torsades de pointes, VT, or cardiovascular collapse
How to reduce the risk of toxicity:
-Avoid overdosing
-Avoid hypothermia, hypoxia, hypercarbia, acidosis, hyperkalemia
-Inject slowly
-use test dose
Dosing is standard _________ of
________to achieve a
block to the level of the umbilicus.
1ml/kg
0.2% Ropivacaine
Caudal anesthesia is most often used for kids under _____ and for ______ cases
-under 2 years of age
-urology
Max single dose of Bupivicaine:
3mg/kg
Max single dose of Levobupibicaine:
3mg/kg
