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A Review of Regional Anesthesia in Infants.
Paediatr Drugs 2019; 21(6):439-449PD

Abstract

Regional anesthesia provides effective anesthesia and pain relief in infants with age-specific data attesting to safety and efficacy. Regional anesthesia decreases exposure to opioids and general anesthetic agents and associated adverse drug effects, suppresses the stress response, and provides better hemodynamic stability compared to general anesthesia. Regional anesthesia can prevent long-term behavioral responses to pain. As a result, the overall number and variety of nerve blocks being used in infants is increasing. While neuraxial blocks are the most common blocks performed in infants, the introduction of ultrasound imaging and a better safety profile has advanced the use of peripheral nerve blocks. Infant-specific pharmacokinetic and pharmacodynamic data of local anesthetic medications are reviewed including risk factors for the accumulation of high serum levels of unbound, pharmacologically active drug. Bupivacaine accumulates with continuous infusion and 2-chloroprocaine can be used as an alternative. Local anesthetic systemic toxicity has the highest incidence in infants less than 6 months of age and is associated with bolus dosing and penile nerve blocks. Local anesthetic toxicity is treated by securing the airway, suppression of seizure activity and implementation of cardiopulmonary resuscitation. Administration of intralipid (intravenous lipid emulsion) is initiated at the first sign of toxicity. A high level of expertise in regional anesthesia is needed when treating infants due to their unique development.

Authors+Show Affiliations

Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. Karen.boretsky@childrens.harvard.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31628666

Citation

Boretsky, Karen R.. "A Review of Regional Anesthesia in Infants." Paediatric Drugs, vol. 21, no. 6, 2019, pp. 439-449.
Boretsky KR. A Review of Regional Anesthesia in Infants. Paediatr Drugs. 2019;21(6):439-449.
Boretsky, K. R. (2019). A Review of Regional Anesthesia in Infants. Paediatric Drugs, 21(6), pp. 439-449. doi:10.1007/s40272-019-00360-8.
Boretsky KR. A Review of Regional Anesthesia in Infants. Paediatr Drugs. 2019;21(6):439-449. PubMed PMID: 31628666.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Review of Regional Anesthesia in Infants. A1 - Boretsky,Karen R, PY - 2019/10/20/pubmed PY - 2019/10/20/medline PY - 2019/10/20/entrez SP - 439 EP - 449 JF - Paediatric drugs JO - Paediatr Drugs VL - 21 IS - 6 N2 - Regional anesthesia provides effective anesthesia and pain relief in infants with age-specific data attesting to safety and efficacy. Regional anesthesia decreases exposure to opioids and general anesthetic agents and associated adverse drug effects, suppresses the stress response, and provides better hemodynamic stability compared to general anesthesia. Regional anesthesia can prevent long-term behavioral responses to pain. As a result, the overall number and variety of nerve blocks being used in infants is increasing. While neuraxial blocks are the most common blocks performed in infants, the introduction of ultrasound imaging and a better safety profile has advanced the use of peripheral nerve blocks. Infant-specific pharmacokinetic and pharmacodynamic data of local anesthetic medications are reviewed including risk factors for the accumulation of high serum levels of unbound, pharmacologically active drug. Bupivacaine accumulates with continuous infusion and 2-chloroprocaine can be used as an alternative. Local anesthetic systemic toxicity has the highest incidence in infants less than 6 months of age and is associated with bolus dosing and penile nerve blocks. Local anesthetic toxicity is treated by securing the airway, suppression of seizure activity and implementation of cardiopulmonary resuscitation. Administration of intralipid (intravenous lipid emulsion) is initiated at the first sign of toxicity. A high level of expertise in regional anesthesia is needed when treating infants due to their unique development. SN - 1179-2019 UR - https://www.unboundmedicine.com/medline/citation/31628666/A_Review_of_Regional_Anesthesia_in_Infants L2 - https://dx.doi.org/10.1007/s40272-019-00360-8 DB - PRIME DP - Unbound Medicine ER -
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