Caudal Anesthesia and Peds

Question 1

Most commonly used regional block in pediatrics.

Answer 1

Caudal

Question 2

Contraindications of Caudal blocks

Answer 2

-Pilonidal cyst
-Abnormal superficial landmarks
-Myelomeningocele pts
-Hydrocephalus or intracranial hypertension
-Neuropathies
-Parent non-consent

Question 3

Needle choices for caudal block

Answer 3

Blunt Caudal needle
Tuohy needle
22 G/20 G angio-catheter

Question 4

Positioning for caudal block

Answer 4

Lateral position with legs/hips flexed into fetal position – keep an eye on the airway!

Prone position

Question 5

Ropivacaine 0.2% dosing for caudal block

Answer 5

0.2% 1 ml/kg

Question 6

The _______ depends upon the needed level of anesthesia.

Answer 6

VOLUME

Question 7

The _______ depends upon the patient’s weight and the concentration of the local

Answer 7

Dose

Question 8

The caudal epidural space in children needs a __________ in order to fill the loosely packed space and spread to reach the appropriate ________.

Answer 8

high volume
dermatomes

Question 9

Sacral level block

Answer 9

0.5-0.75 mL/kg

Question 10

Lumbar level block

Answer 10

1.0-1.2 mL/kg

Question 11

Low thoracic block

Answer 11

1.2-1.5 mL/kg

Question 12

Maximum volume

Answer 12

25 ml

Question 13

Max dose

Answer 13

3mg/kg

Question 14

Regional toxicity treatment

Answer 14

Use 20% intralipid solution

Bolus
1.5 mL/kg
repeat 1-2 times if needed

Infusion
0.25 mL/kg/min for 30-60 minutes

Question 15

Signs of intravascular injection (test dosing)

Answer 15

-HR increase of 10bpm
-BP increase of 15mmHg
-T wave amplitude increase of > 25%
-Bradycardia

Question 16

Why are children at an increased risk of local toxicity?

Answer 16

Increased CO and increased systemic uptake of agent

Question 17

Toxicity results in direct________toxicity and _______ toxicity.

Answer 17

-central nervous system
-cardiac

Question 18

Neurotoxicity symptoms:

Answer 18

HA, somnolence, vertigo, perioral or lingual parathesias, tremors, twitching, shivering or convulsions

Question 19

Cardiac toxicity:

Answer 19

LA prevents the fast inward sodium channels in the myocardium from opening.

Dysrhythmias, conduction block, widening QRS, torsades de pointes, VT, or cardiovascular collapse

Question 20

How to reduce the risk of toxicity:

Answer 20

-Avoid overdosing
-Avoid hypothermia, hypoxia, hypercarbia, acidosis, hyperkalemia
-Inject slowly
-use test dose

Question 21

Dosing is standard _________ of
________to achieve a
block to the level of the umbilicus.

Answer 21

1ml/kg
0.2% Ropivacaine

Question 22

Caudal anesthesia is most often used for kids under _____ and for ______ cases

Answer 22

-under 2 years of age
-urology

Question 23

Max single dose of Bupivicaine:

Answer 23

3mg/kg

Question 24

Max single dose of Levobupibicaine:

Answer 24

3mg/kg

Question 25

Max single dose of Ropivacaine:

Answer 25

3mg/kg

Question 26

Max single dose of Lidocaine:

Answer 26

5mg/kg

Question 27

Max single dose of Lidocaine w/ Epi:

Answer 27

7mg/kg

Question 28

All doses for continuous infusion rates in infants < 6months (except LIDOCAINE)

Answer 28

0.2-0.25 mg/kg/hr

Question 29

Lidocaine continuous infusion rate for infants < 6 months

Answer 29

0.8 mg/kg/hr