250 CASES SPINAL ANESTHESIA CHILD UNDER 7 YEARS OF OPERATING AREA BELLY BUTTON:

SAFETY AND EFFECTIVENESS

World: SA method will become an important place

in children's surgery in the future. Tyrrell Gray

said at the beginning of the 20th century.

1984 Abjian successfully launched and

developed SA to the modern era.

Vietnam: From 2006, a number of authors have

applied and reports but also small numbers and

limited

PUT THE MATTER

From this reason we conducted research on:250 CASES SPINAL ANESTHESIA CHILD UNDER 7 YEARS OF

OPERATING AREA BELLY BUTTON : SAFETY AND

EFFECTIVENESS

With the aim of:

1. To evaluate the safety and efficacy of the method

2. Evaluation of unwanted effects during and after

surgery.

PUT THE MATTER

Location: Perform at Children's Hospital Central from May 01 - 09/2009

Research Methodology: Progress clinical trial 250 cases were divided into 3 groups:

+ Group I: Neonatal ≤ 1 year of age (n = 41)

+ Group II:> 1 year old - ≤ 3 years (n = 113)

+ Group III:> 3 years - <7 years of age (n = 96) Insensitivity: Servoral face mask and maintained at 0.5% - 1% Dose:

- Bupivacaine 0.5 mg / kg ≤ 4kg children

- Bupivacaine 0.4mg / kg for children ≤ 15 kg less than 5mg

- Bupivacaine 0.3mg children> 15 kg, not more than 7mg

METHOD

RESULT AND DISCUSSION

Breathing through the point

- The trend of decreasing stability in physiological limits.- No case has time or SPO2 <95% (n <0.01)- No bronchospasm, slow breathing or apnea.

SAFETY Respiratory

RESULT AND DISCUSSION

SAFETYHeartbeat Average blood pressure

Heart rate over time

- Trends and stable reduction in physiological limits (P <0.01).- No case is used atropine to lift.

Average blood pressure over time

- Reduce and stability in physiological limits (P <0.01)- No case low BP is used Ephedril- Some speed infusion

RESULT AND DISCUSSION

- TG Hannu Kokki (n = 475) newborn-17 years old), L3-4, 0.3mg/kg

SPO2 <90% 5% 3% bradycardia heart

- 2% of children appear lower BP> 10 years of age, the majority return to normal

+ Hendolin (n = 120) 2% low BP infusion

4% bradycardia atropine

+ William (n = 1554) SPO2 <90% 0.6%

Bradycardia < 100 beat per minute is 1.6%

+ Imbelloni (n = 307) 0.3% low BP

0.6% bradycardia

SPO2 < 90% no patients

SAFETY

RESULT AND DISCUSSION

- Bang - Vojdanovsky: Blood pressur during

insensitivity in children <6 years old and only

lowering BP in group> 6 years old.

- Like the comments of Wu CL, Fleisher, Doli:

sympathetic blockers usually occurs in adults

but rare among children <5 years of age.

SAFETY

RESULT AND DISCUSSION

Thus: In our study similar to the authors:

SA position L3-4 with bupivacaine 0.5% to

respiration in children <7 years old and

SPO2 decreased apnea is very rare, very

little influence hemodynamics is pretty

convincing voiced safety of the method.

SAFETY

RESULT AND DISCUSSION

* In the study:

-The level of anesthesia was 100% right T6

-Time of departure numbness 1mins (accounting for 98.8%) after 2mins (1.2%)

-Duration of pain in surgery at T10: increasing in older children, group I: 60.3 ± 14.5; Group II: 75.6 ± 19.7; Group III: 88.7 ± 19.9 (p <0.05)

-Good Quality numb 97.2%, average: 2.8%

-No patients have moved PP insensitive or painkillers

EFFECTIVENESS

The insensitivity

Time of departure numbness

Duration of pain relief in

surgery

Good Average

Kokki (0.4mg; L3-4)T4

< 3mins (96%)

103p < 6 y

Other studies different from Kokki

T10 152p > 10 y

Other studies different from Kokki T10 91 ± 104p

Imbelloni (0.3mg L3-4)

T62.36 ±0.95

76.8 ± 6.6p

William and Robert (1554 children)

94.5% 4.6%

Kokki (n = 475)92% 7%

RESULT AND DISCUSSION

EFFECTIVENESS

RESULT AND DISCUSSION

The results of our study fit Kokki author, Imbelloni

about the insensitivity related to dose,

concentration and weight with bupivacaine 0.5%,

0.3 ± 0.5mg dose / kg. SA L3-4 inhibit pain

sensation below the navel well for belly-button

surgery from T10 without taking any other

painkillers with an average time of 70 ± 90mins.

EFFECTIVENESS

RESULT AND DISCUSSION

* Time inhibition and recovery leg movement:

-Nhibition of leg movement: fast lose 100% <2 mins in all 3 groups? (P>

0.05)

-Restoration leg movement: TB 3 groups: 42.8 ± 36.2 mins (p> 0.05)

-Imbelloni (n = 307), 0.5 mg L3-4: inhibition of movement <2 mins,

recovery 75% leg movement in level 1 and 0 at the end of surgery.

Level 2: 16%; Level 3: 9%

-Puncuh (n = 1132) 0.2mg / kg L3-4: motor recovery time is usually

observed only after 20ph since inhibition of movement, muscle function

returned before the return of sensation.

EFFECTIVENESS

* Results of the study showed: time running short blockades, inhibition feeling fast recovery time faster leg movement should allow:

-Carry out the surgery immediately

-Quickly change surgeries save time.

-Lets go back early, early hospital discharge

-Use good for outpatients, day surgery or the risk of respiratory depression.

EFFECTIVENESS

RESULT AND DISCUSSION

RESULT AND DISCUSSION

* Time postoperative pain relief in the short-term studies in children less gradual age (p <0.05). Average all 3 groups were: 108.9 ± 59.5 minutes; Min: 10 min, 250 min max.

-All 3 groups had 22.8% after crying to get fascinated with struggling (group I, II mainly) quiet when mothers (p <0.01).

-After 20 hours: 45 young group III (46.8%) reported no pain or surgery.

EFFECTIVENESS

RESULT AND DISCUSSION

- Hannu Kokki (n = 195) children 6 months - 10 years old

outpatient inguinal hernia surgery. Authors found

postoperative patients do not have severe pain, pain

during rest and with exercise, 28% used pain while lying

in resuscitation. 65% did not hurt in the first seconds

after surgery, 17% moderate pain, severe pain 2%.

Thus SA postoperative L3-4 children are quiet, calm,

showed good postoperative analgesia children, reduce

injuries from anesthesia and surgery and is also an

important factor for outpatient surgery.

EFFECTIVENESS

RESULT AND DISCUSSION

* Side effects after surgery:-Vomiting 3 patients in group III-Headache accounted for 3.1% of children with group II, light and short.-Peneuh (n = 1132) patients with no vomiting, headache 5 patients.-Imbelloni (n = 307): patients with no vomiting, headache, 3 patients with mild and brief.-Kokki (n = 475): vomiting 5%, 5% headache.-Wee LH, Lam F (n = 105): Group children <10 years old with no headaches, 10-12 years old with 11.8%, 50% 13-18 years old.

→ Thus, in SA in vomiting and nausea sinks very low in young children, but this is very frequent in children under general anesthesia. Headache was also lower in young children and are usually mild, short but significant increase in the older children.

EFFECTIVENESS

CONCLUSION

Through the study on 250 patients from birth to <7 years we have some conclusions:

Maintain respiratory and hemodynamic stability in SA. Effect on respiration rate high safety, reduce blood oxygen saturation, apnea is a rare and little influence hemodynamic, if there are mild and short.

Ensure good insensitivity to the surgery below the navel.

Side effects are less common, usually mild and transient.

Technical easy to implement, without fail. Gain acceptance as a replacement anesthetic for other methods.

THANK YOU!