Akademik Veri Yönetim Sistemi
European journal of anaesthesiology, cilt.40, ss.465-471, 2023 (SCI-Expanded, Scopus)
BACKGROUNDCaudal injections commonly used for neuraxial anaesthesia in children can displace cerebrospinal fluid cranially causing safety concerns in terms of raised intracranial pressure. Optic nerve sheath diameter (ONSD) is a noninvasive surrogate for the measurement of intracranial pressure. Regional cerebral oximetry (CrSO2) can monitor brain oxygenation, which may decrease by a reduction in cerebral flow due to increased intracranial pressure.OBJECTIVESComparing how caudal injection volumes of 0.8 and 1.25 ml kg(-1) influence ONSD and CrSO2 within the first 30 min after injection.DESIGNProspective, randomised and parallel group trial.SETTINGOperating room.PATIENTSFifty-eight elective paediatric surgical patients between ages 1 and 7 years old, ASA class I or II, without previous intracranial or ocular pathology and surgery appropriate for single-shot caudal anaesthesia.INTERVENTIONSingle-shot caudal anaesthesia with 0.8 ml kg(-1) (group L, n = 29) and 1.25 ml kg(-1) (group H, n = 29) of 2 mg kg(-1) bupivacaine solution.MAIN OUTCOME MEASURESOptic nerve sheath diameter measured with ultrasonography and regional cerebral oximetry measured by near-infrared spectroscopy before (NIRS), immediately after, 10, 20 and 30 min after the block.RESULTSMean ONSD values increased from a baseline of 4.4 +/- 0.2 mm to a maximum of 4.5 +/- 0.2 mm 20 min after injection in group L and from a baseline of 4.5 +/- 0.3 mm to a maximum of 4.8 +/- 0.3 mm 10 min after injection in group H. Eight of 29 patients in group H and none in group L had an ONSD increase by more than 10%. Both groups had a reduction of less than 2.5% in CrSO2.CONCLUSIONCaudal injection with 1.25 ml kg(-1) increased ONSD, an indirect measurement of ICP, more than 0.8 ml kg(-1) and neither volume caused a clinically important reduction in CrSO2.