ORIGINAL ARTICLE   

Minerva Anestesiologica 2022 January-February;88(1-2):16-22

DOI: 10.23736/S0375-9393.21.15716-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Perioperative sedation requirements of infants aged 0 to 3 months subjected to lower-body surgery under caudal blockade: a randomized controlled trial

Werner SCHMID ¹ ✉, Peter MARHOFER ², Oliver KIMBERGER ¹, Daniela MARHOFER ¹, Stephan KETTNER ³

¹ Department of Anesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria; ² Department of Anesthesiology and Intensive Care Medicine, Orthopedic Hospital Speising, Vienna, Austria; ³ Vienna Hospital Association, Department of Anesthesiology and Intensive Care, Karl Landsteiner Institute for Anesthesiology and Intensive Care Medicine, Hospital Hietzing, Vienna, Austria

BACKGROUND: It remains unclear how much sedation is required for subumbilical surgery under caudal blockade, and sedatives may carry a poorly understood risk of late sequelae in infants. We designed a randomized controlled study to evaluate total propofol consumption and perioperative sedation quality with the avoidance of continuous perioperative sedation in infants undergoing surgery under caudal anesthesia.
METHODS: Thirty-two infants (age: 0-3 months) were randomized to one of two groups in which perioperative administration of propofol was provided either “as needed” or by continuous infusion (5 mg kg^-1 h^-1). After induction of anesthesia via a facemask with sevoflurane, a venous access was established and 1 mL kg^-1 of ropivacaine 0.35% was injected for caudal anesthesia. Intraoperative stress was assessed by repeated recording comfort behavioral scale scores and heart rates.
RESULTS: Significantly (P=0.0001) less propofol was administered in the as-needed group (0.7±1.4 mg/kg) than in the continuous-infusion group (3.0±1.6 mg/kg). This difference was not reflected in different requirements of additional intraoperative sedation (0.5±0.8 mg/kg in 5 versus 0.6±1.0 mg/kg in four cases; P=0.76).
CONCLUSIONS: As needed propofol administration offers no disadvantage in terms of intraoperative sedation, but significant dose reductions can be achieved by avoiding continuous propofol infusion.

KEY WORDS: Anesthesia, caudal; Ultrasonography; Ropivacaine; Infant; Deep sedation; Propofol