Anesthesia in toddler

akcarmean, LPN · Dec 1, 2004

my son had to have tubes put in and was put under. he was just a year old. Things went very well and he had no problems. Hope this helps.

Angelia

Just a CRNA · Dec 1, 2004

Hello all - I have a question. I have a 2 year old boy who may need to be circumcised in the near future. I am fine with the procedure itself, but I am very anxious about having him put under general anesthesia. What are the main risks in this age group? Is it more difficult to manage the airway on these little guys? I have not had the consultation with the surgeon or anesthesiologist yet, but I am wondering what are good questions to ask them before I decide to have this done (he has had several problems related to not being circ'd). Thanks for any advice!!

General anesthesia with an LMA works well for this procedure. Some like to inject some caudal anesthesia also...works nicely if they are proficient with this block.

jwk · Dec 1, 2004

Hello all - I have a question. I have a 2 year old boy who may need to be circumcised in the near future. I am fine with the procedure itself, but I am very anxious about having him put under general anesthesia. What are the main risks in this age group? Is it more difficult to manage the airway on these little guys? I have not had the consultation with the surgeon or anesthesiologist yet, but I am wondering what are good questions to ask them before I decide to have this done (he has had several problems related to not being circ'd). Thanks for any advice!!

Anesthesia is easy in kids - they go to sleep quickly and wake up quickly. Airway management is usually very easy. Mask or LMA are fine.

Your surgeon may consider a penile block while he's asleep. They're done very commonly from newborns to adults. I have no experience with caudals, but it sounds like a little overkill, and I wouldn't consider having one done on my child unless this was a pediatric anesthesiologist or anesthetist with LOTS of experience. I've done lots of anesthetics for kiddie circs in 25 years, never seen a caudal for one. Not saying it's necessarily a bad thing, but again, it seems a little but of overkill, IMHO.

gaspassah · Dec 1, 2004

well i'm not a pediatric anesthesiologist nor an anesthetist yet. but i did severl caudal blocks during my pediatric rotation. it is a relatively simple procedure but vigilance remains a must, allows for much lower depth of general anesthesia *caudals are best for postoperative pain, not instead of ga* and quicker recoveries

incidence of a neural injury are low as you are injecting in the caudal space so there are fewer nerves to injure in this area. ie a 2 year olds cord ends approxiately at L1 and the dural and arachnoid sacs end near S2. these structres are close and thusly correspond to the risks associated with the procedure.

the main risks as with any block are intravascular injection, subdural inj, and nerve inj, and local anesthetic toxicity.

the pediatric hosp i did my kids rotation at did tons of caudals, almost any procedure from the umbilicus down got a caudal.

both texts: hahn's regional anesthesia and smith's anesthesia for infants and children note that provider skill is an important component. but they also state that caudel anesthesia is an excellent adjunct for all ambulatory sugeries in infants and children undergoing umbilicus and below surgery. as the concentration of local anesthetic, 0.25% or 0.125% bupivicaine will offer sensory block with little to no motor block.

as a matter of fact i hope to do one in the morning for a pat. having a circ redo.

good luck to you and your son. whatever you choose.

d

jwk · Dec 1, 2004

That's what I get for not doing kids anymore - the world just passes me by.

Quincke · Dec 2, 2004

I think it depends on where you are having the procedure done as to whether a penile or caudal block would be done. From what I have seen, the main place near me that does regular caudal blocks on children is the pediatric only hospital. Most other hospitals do penile blocks for children having circs along with general anesthesia.

As far as questions to ask, ask about the risk and benefit of whatever anesthesia that will be done (Gaspassah stated several of them earlier).

Good luck:)