Cardiorespiratory responses to epidural analgesia in the awake child: a retrospective review of postoperative patients.

The authors retrospectively evaluated the cardiorespiratory effects of epidural administration of bupivacaine in 17 awake children during the immediate postoperative period. Responses to dosing were assessed by comparing heart rate, blood pressure, and respiratory rate before and after administration. Additionally, hourly heart rates were compared between those patients receiving intermittent bolus doses and those receiving a continuous infusion. The patients included 11 boys and 6 girls, ranging in age from 4 months to 12 1/2 years and in weight from 7.4 to 48 kg. All catheters were placed after the induction of general anesthesia. Surgical procedures included exploratory laparotomy (9 patients), bladder reconstruction (4 patients), wound debridement and skin grafting (2 patients), amputation (1 patient), and Nissen fundoplication (1 patient). A total of 37 bolus doses of 0.25% bupivacaine were administered to 7 patients. A significant (P < .001) decrease in heart rate (187 +/- 2 to 137 +/- 1 beats/min), respiratory rate (42 +/- 2 to 25 +/- 1 breaths/min), and systolic blood pressure (125 +/- 3 to 86 +/- 1 mm Hg) was noted after administration. When postdosing cardiorespiratory parameters were compared with preoperative values obtained the day before surgery during the preoperative anesthesia evaluation, there was no significant difference in heart rate (131 +/- 14 versus 137 +/- 13 beats/min), respiratory rate (21 +/- 7 versus 25 +/- 1.0 breaths/min), and systolic blood pressure (93 +/- 9 versus 86 +/- 2 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)