Clinical Research Of The Application Of Continuous Epidural Anesthesia Through Sacral Canal In Pediatric Operation On Abdominzl Region

Objectives To study the safety and effect of continuous epidural anesthesia through sacral canal combined with light general anesthesia in pediatric operation on abdominal region. And to study the effect of block level in different length of epidural catheter.Methods Seventy-four patients of operation on abdominal region (ASAⅠ～Ⅱ,20 days～3 years old) were divided into three groups with 21 cases in control group,29 in experimental group 1 and 24 in experimental group 2. Stabbed with AS-E transfixion pin, epidural catheters were inserted into the level according to the operation in experimental group 1, while epidural catheters were inserted into the level of S1-L5. Patients in all the three groups were fasting 4～6 hours and before 30min of operation both 0.01 mg·kg-1 atropine and 1mg·kg-1 phenobarbital sodium were intramuscular injected. Then 5 mg·kg-1 ketamine were intramuscular injected to make the patients asleep out of the OR. After the catheter inserted into the set epidural space through sacral hiatus and SIEMENS AG X-ray Equipment used to confirm the placement of it, 0.8%～1.5% lidocaine, 8～10mg·kg-1 (capacity equals 0.6 ml-kg-1) were injected. Midazolam 0.1 mg-kg-1,Fentanyl 2～3μg-kg-1 and vecuronium 0.1mg·kg-1 were delivered to induce and tracheal intubate,0.5%～1% isoflurane and proper dose of propofol to maintain for sedation during the surgery. For time of operation longer than 2 hours, the control group was boosted Fentanyl 1～2μg·kg -1 and vecuronium 0.05mg·kg -1 while the experimental groups were injected one third of the lidocaine's full dose every 30～40min. The blood pressures, heart rates and saturation of blood oxygen values were recorded in different moments. The duration of operation and anesthetic needed, general anesthetic's consumption and recovery time were compared among three groups. The length and accuracy setting of the catheters inserted, levels of epidural block were also compared between the two experimental groups.Results Finally there were 66 patients were choosen in the experiment for several reasons, which there were 20 cases in control group and 23 cases in both two experimental groups respectly. Compared with control group, changes of SBP,DBP and HR were smaller and the general anesthetic's consumption was obviously less (p<0.05), meanwhile both the recovery time of spontaneously breathing and time of extubation were remarkably shorter in experimental groups (p<0.05). Compared with experimental group 1, the length of the catheters inserted in experimental group 2 were much longer (p<0.05).Yet the levels of epidural block, the general anesthetic's consumption and the changes of vital signs had no significant differences in two experimental groups (p>0.05) Conclusions With smaller changes in circulation system and shorter recovery time, application of continuous epidural anesthesia through sacral canal combined with light general anesthesia in pediatric operation on abdominal region is safe and effective. As long as the top of epidural catheter gets to the level of S1～L5 space, the level of sensory deprivation may reach T4～T6 space matching the requirements of analgesia and muscle relaxation in pediatric operation on abdominal region, which is good for postoperative pain management.