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Michael de la Pea MartnezUniversidad de CartagenaAnestesiologa y Reanimacin2012Anestesia Neuroaxial en Pediatra

Neuraxial anesthesia

Diferencias Anatmicas Neuraxial anesthesia

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Diferencias Anatmicas Neuraxial anesthesia

Figure 42-5. Distance from the skin to the subarachnoid space as a function of age. (Data from Bonadio WA, Smith DS, Metrou M, et al: Estimating lumbar puncture depth in children. N Engl J Med 1988; 319:952-953; Kosaka Y, Sato K, Kawaguchi R: [Distance from the skin to the epidural space in children.] Masui 1974; 23:874-875; LauHP: [The distance from the skin to the epidural space in a Chinese patient population.] Ma Tsui Hsueh Tsa Chi 1989; 27:261-264.)

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Diferencias Anatmicas Neuraxial anesthesiaLCR Neonato 4ml/kg / Adulto 2ml/kg LCR en ESA ~ 50% / 25%

Figure 42-6. Approximate volume of cerebrospinal fl uid (CSF) relative to weight and age. Note that preterm and full-term infants have a much greater CSF volume relative to weight than a child or adult; this may account in part for the increased dose (mg/kg) of local anesthetic required in infants to produce a successful subarachnoid blockSe igualan al ao de edad5

Neuraxial anesthesia

S1 NeonatosL5 InfantesL4-L5 NiosL4 adolecentesL3-L4 AdultosDiferencias Anatmicas

Neuraxial anesthesiaAnestesia Espinal

1901Reducir la apnea POP en prematuros y ex prematuros

Neuraxial anesthesia

8Anestesia Espinal

Neonato: Aguja espinal 22G de 1/2 pulgada> 2 aos

Dosis (Hasta 10x dosis proporcional)Bupivacaina isobrica/Hiperbarica < 5Kg: 0.5-0.6mg/kg 5-15Kg: 0.4mg/kg > 15kg: 0.3mg/kg Neuraxial anesthesia

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Neuraxial anesthesia

Anestesia Espinal: Complicaciones

CPPD10 50% en Px entre 10 - 18aosCafena 300-500mg 1 o 2 veces/daLIV, reposo, analgsicos oralesParche de sangre: 0.3ml/kg (> 48h)

Anestesia Espinal TotalNo cambios hemodinmicos en < 5 aos

Neuraxial anesthesiaUso poco de A espinal en niox11

Neuraxial anesthesia

Neuraxial anesthesia

1933 y 196013

Neuraxial anesthesia

Bupi Levo0.175% 0.2% < 5a: 10-13h6-10a: 2-3h> 10a: 1-2h > volumen es mejor que > [ ], Ketamina, Tramadol14Anestesia Caudal: Complicaciones

Aplicacin intravascular, Espinal o Medula sea sacra> Incidencia de colonizacin (20%)Retencin urinaria, debilidad muscular, prurito, o nuseas y vmitos Neuraxial anesthesia15Anestesia Caudal: Contraindicaciones

Quiste pilonidalMarca superficial anormal a nivel sacroMeningitisMielomeningoceleNeuropata degenerativa progresiva

Neuraxial anesthesia16

Neuraxial anesthesiaAnestesia Epidural

Neuraxial anesthesia

Ligamentos mas laxosAngulacin de agujaMedula ocupa la mayora del espaacio

18Anestesia Epidural

Bolo 0.3-0.5ml/kg

Colonizacin 4%

Neuraxial anesthesia

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