A report of two hundred twenty cases of regional anesthesia in pediatric cardiac surgery

The use of regional anesthesia (ie, epidural, spinal, or caudal) has been r eported in a few small series of children undergoing cardiac surgery, but n ot in larger studies. In this retrospective, descriptive study, we report t he results of the use of regional anesthesia in 220 pediatric cardiac opera tions. We reviewed the records of children receiving a regional anesthetic for cardiothoracic surgery at Stanford Medical Center between January 1993 and February 1997. All patients were targeted for early tracheal extubation . A variety of regional techniques were used. Time to extubation, control o f pain, incidence of respiratory depression and other complications, and le ngth of hospital stay were determined. There were no deaths. Eighty-nine pe rcent of the patients were tracheally extubated in the operating room; 4.1% of whom required reintubation within 24 h. Ninety-five percent +/-25% of t he patients had pain scores less than or equal to 4.0 at all intervals post operatively. Adverse effects of regional anesthesia included emesis (39%), pruritis (10%), urinary retention (7%), postoperative transient paresthesia (3%), and respiratory depression (1.8%). The incidence of peridural hemato ma was zero. The rate of adverse effects was lower in the thoracic ca thete r epidural approach as compared with various caudal, lumbar epidural, and s pinal approaches. Hospital duration of stay was not effected by the presenc e of regional anesthetic complications. In this study, regional anesthesia was safe and effective in the management of pediatric patients undergoing c ardiac surgery.