Due to the development of modern anesthesiology, the increasing safety of general anesthesia has become the preferred way of anesthesia for infant surgery. However, intravenous anesthesia and inhalation of anesthetics have shown certain neurotoxic effects in animal experiments, making the medical community more concerned about the long-term effects of general anesthetics on infants.
There is no evidence of evidence-based medical evidence for the long-term effects of general anesthetics on infant intelligence development. Some experts even claim that the operation time of infants and young children should be delayed to 3 years old. However, it is necessary for the infants to receive more acute or limited surgery at this stage. To find a safer and more reliable way of anesthesia.
Sacral anesthesia is a kind of anesthesia technique commonly used in the operation of children's abdominal and lower extremities. It has the advantages of perfect analgesia and stable hemodynamics after operation. It usually does not need trachea intubation and little need for inhalation of general anesthesia medicine. Therefore, it is quick to wake up and improve the analgesia, and can reduce the possibility of restlessness in children. The sacral canal's anatomical landmark is obvious, and the dorsal surface of the sacrum is flat, and the sacral prominence is palpable. The success rate of puncture can reach more than 95% under the manipulation of skilled anesthesiologists. However, sacral anesthesia is still a tendency to be replaced by general anesthesia in general people who believe that the anesthesia risk is relatively high, and the children are not easy to cooperate with.
MS and Alexander, from the University of Vermont medical center and the Columbia University, were compared with the operation under general anaesthesia under the sacral canal anesthesia in infants and infants under general anesthesia. It was pointed out that the sacral canal anesthesia has the effect of reducing the children's exposure to general anesthesia and avoiding the long-term effect of the total anesthetics on the mental development of the children. To reduce the advantage of the occupation of medical resources. The article is published in the Regional Anesthesia and Pain Medicine magazine.
424 infants who were treated with pyloric cytomy were selected, of which 218 infants from the University of Vermont Medical Center (UVM) were operated under sacral anesthesia, while 206 infants from the Columbia University Medical Center (CUMC) were operated under general anesthesia. The advantages and disadvantages of sacral and general anesthesia were evaluated from two aspects of the incidence of adverse events within 48 hours after the operation and the medical resources occupied (including the operation time and the average hospital day after operation).
Caudal anesthesia was performed in all children undergoing UVM pylorus myotomy. 210 of them were successfully punctured to achieve the ideal level of anesthesia, with a success rate of 96.3%. In addition, 8 children underwent sacral anesthesia for general anesthesia because the anesthesia level was insufficient to meet the operation needs. Tetracaine was used in 210 cases of successful sacral anesthesia. The average amount of tetracaine was 0.77 mg/kg. 120 cases of children with pyloric ring muscle incision under CUMC general anesthesia were intubated by conscious tracheal intubation, and 86 cases had rapid induction sequential intubation.
There were 11 cases of adverse events (5%) in the sacral anesthesia group: 2 cases of larynspasm occurred during the operation, including 1 cases of respiratory arrest but no intubation, 1 cases requiring intubation, 4 cases of puncture failure, and 4 cases of inadequacy of anesthesia. There were 16 adverse events in the general anesthesia group (7.8%): difficult intubation in 13 cases, postoperative larynx spasm in 1 cases, and postoperative respiratory arrest in 2 cases. The incidence of adverse events was not statistically significant in the two groups.
Compared with the general anesthesia group, the operation time of the sacral canal anesthesia group was shorter than that of the general anesthesia group. The average time was 69 min and 87.7 min, respectively. Considering the factors of two groups about age, sex, ASA grade 3 and above, and 37 weeks of pregnancy at birth, the operation time of the general anesthesia group was 17.5 min longer than that of the sacral anesthesia group by linear regression analysis. The average postoperative hospitalization day was 1.31 days in the sacral canal anesthesia group and 1.68 days in the general anesthesia group. After adjusting the covariates with Poisson regression, the average postoperative hospital stay in the general anesthesia group was 1.19 times higher than that in the sacral anesthesia group.
Based on the above analysis, the authors believe that the operation time of infants receiving sacral anesthesia is shorter than that of postoperative infants. There was no significant difference in incidence of adverse events compared with general anesthesia, and could reduce the dosage of intravenous general anesthetics and inhalation anesthetics. Although sacral canal anesthesia is used, infants often need to add anaesthesia. Whether these differences are long-term gains is unclear. Further studies are needed to identify the risk of rare side effects, such as aspiration.