A Report of Two Hundred Twenty Cases of Regional Anesthesia in Pediatric Cardiac Surgery

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Abstract
The use of regional anesthesia (ie, epidural, spinal, or caudal) has been reported in a few small series of children undergoing cardiac surgery, but not in larger studies. In this retrospective, descriptive study, we report the results of the use of regional anesthesia in 220 pediatric cardiac operations. We reviewed the records of children receiving a regional anesthetic for cardiothoracic surgery at Stanford Medical Center between January 1993 and February 1997. All patients were targeted for early tracheal extubation. A variety of regional techniques were used. Time to extubation, control of pain, incidence of respiratory depression and other complications, and length of hospital stay were determined. There were no deaths. Eighty-nine percent of the patients were tracheally extubated in the operating room; 4.1% of whom required reintubation within 24 h. Ninety-five percent ±2.5% of the patients had pain scores ≤4.0 at all intervals postoperatively. Adverse effects of regional anesthesia included emesis (39%), pruritis (10%), urinary retention (7%), postoperative transient paresthesia (3%), and respiratory depression (1.8%). The incidence of peridural hematoma was zero. The rate of adverse effects was lower in the thoracic catheter epidural approach as compared with various caudal, lumbar epidural, and spinal approaches. Hospital duration of stay was not effected by the presence of regional anesthetic complications. In this study, regional anesthesia was safe and effective in the management of pediatric patients undergoing cardiac surgery. The study demonstrates the techniques and feasibility of the use of regional anesthesia in pediatric patients undergoing a variety of cardiothoracic operations. Regional anesthesia is compatible with immediate extubation after cardiopulmonary bypass in pediatric patients. The thoracic (T6–12) catheter epidural approach may be preferable to other regional approaches. There were no cases of symptomatic periduaral hematoma in 220 patients.