[Intradural anesthesia: an alternative in surgery on premature infants]. / Anestesia intradural: una alternativa en la cirugía en los lactantes prematuros.

The greater survival of premature infants, the frequency with which these children present a pathology of surgical treatment, and their physiological immaturity, particularly in the respiratory system, entail a great many difficulties in the postoperative process. With the aim of decreasing these postoperative difficulties and because of the publications of several articles with the same goal, it is implemented a study of spinal anesthesia with isobaric bupivacaine in the premature babies put under a treatment or surgery of the inguinal canal, in order to asses the efficiency of this technique and the cardiovascular consequences. The average duration of the anesthesia was 59 +/- 13 minutes. The latency period is practically nonexistent and the average level that was achieved is situated between D4-D6, which is enough so as to carry out the operation without problems and achieving a complete analgesia in the inguinal area. It has not been observed relevant hemodynamic alterations. The outcomes are obvious, for the difficulties disappear, especially those coming from the respiratory system in the general anesthesia with intubation such as apnea, cyanosis and bradycardia, stridor and atelectasis. This kind of anesthesia allows the surgeon a perfect relaxation and analgesia and the children a comfort throughout the surgical event. By way of conclusion, the spinal anesthesia is a good option instead of the general anesthesia for suckling babies because of the risk of respiratory difficulties they present, alone all when they are premature and they are recovering from a syndrome of respiratory difficulty.

[Anesthesia and lumbar epidural anesthesia in an infant with third-degree burns]. / Anestesia y analgesia epidural lumbar en un lactante afecto de quemaduras de tercer grado.

Epidural route is widely used in adults for injection of drugs, but it is not so often used in pediatric patients. We present the case of a 8 month old burned infant who received anesthesia and analgesia through a lumbar epidural catheter. The insertion of epidural catheter is described. Two surgical procedures were performed under epidural anesthesia with 0.5% bupivacaine an epinephrine 1:200.000 (2.5 mg/kg). 16 hours of postoperative analgesia was obtained with epidural morphine (0.05 mg/kg). No side effects were seen. We analyze the uses of epidural anesthesia in pediatric patients, the catheter care in the burned child, the hemodynamic changes observed during anesthesia and the results of peridural morphine.

[Postoperative analgesia using caudal morphine in pediatric surgery: randomized double-blind study compared with bupivacaine]. / Analgesia postoperatoria con morfina por vía caudal en cirugía pediátrica: estudio aleatorio y a doble ciego comparado con bupivacaína.

Morphine and bupivacaine have been administered caudal via to 28 children between 2 and 12 years old for the postoperative pain treatment. All of them were submitted to general anesthesia and randomly divided into 3 groups depending on the drug administered caudal via. a) Morphine group (n = 10): morphine chlorhydrate 50 micrograms/kg (0.5 ml/kg of morphine solution 100 micrograms/ml). b) Bupivacaine group (n = 10): bupivacaine 0.5%, 2.5 mg/kg. c) Control group (n = 8): no drug administered. Pain evaluation was made on the basis of physiological and clinical data. In the morphine group, the postoperative time until analgesia was required 20 +/- 5 hours and analgesia has been significantly better (p less than 0.001) than bupivacaine and control group. The number of analgesic drug needed during the postoperative 24 first hours was also less in morphine group. No differences on postoperative complications were seen among the 3 groups and no case of respiratory depression was observed. It is concluded that epiduro-caudal morphine provides effective and prolonged analgesia and can be safely used for postoperative pain treatment in pediatric urologic surgery. However, we believe, that larger series of patients will provide better information of its efficacy and other side effects.