Pediyatrik Kaudal Anestezi Uygulamalarının Değerlendirilmesi: Ulusal Anket Çalışması

Öz

Kaudal blok pediyatrik rejyonal anestezi pratiğinde çok sık kullanılan bir tekniktir. Ancak klinik pratikte kaudal blok uygulamaları hakkında çok az bilgi mevcuttur. Bu çalışmada Türkiye’de anestezistler tarafından yaygın olarak kullanılan kaudal blok ile ilgili; anestezistin deneyimini, uygulanan teknikleri, kullanılan ilaçları ve kaudal epidural kateter tekniğinin kullanım sıklığını değerlendirmeyi amaçladık. Anket çalışmasına, etik kurul onayı sonrası, 553 Anesteziyoloji ve Reanimasyon uzmanı ve araştırma görevlisi katıldı. Formlar ilgili kişilere posta yoluyla veya elden iletildi. Katılımcıların büyük kısmı uzman anestezi doktoru olarak görev yapmaktaydı ve genelde 5 yıldan az pediyatrik anestezi deneyimine sahiplerdi. Sıklıkla 22- veya 24-gauge mandrenli kaudal iğne kullandıkları, kaudal epidural boşluğa dermoid doku implantasyonu riskinin yüksek olduğunu düşündükleri, aynı zamanda epidural aralığa yerleşimin doğrulanması için klinik belirteçleri kullandıkları saptandı. Lokal anestezik olarak sıklıkla % 0,125-0,25’lik bupivakain ve additif ilaç olarak çoğunlukla opioid kullandıkları, kaudal kateter kullanım oranının çok düşük olduğu ve asepsi yöntemi olarak genelde yalnızca eldiven kullanıldığı görüldü. Genellikle kaudal bloğun indüksiyon sonrası yapıldığı ve anestezi idamesinde inhalasyon anestezisi kullanıldığı, aynı zamanda kaudal bloğun en sık ürogenital operasyonlarda tercih edildiği saptandı. Sonuç olarak, pediyatrik anestezide kaudal bloğun güvenli olarak uygulanması için kullanılan teknik ve ilaçların değerlendirileceği uluslararası katılımlı çok merkezli çalışmalara gereksinim olduğu kanısına vardık.

Anahtar Kelimeler

• pediyatri
• kaudal anestezi
• epidural anestezi

Evaluation of Pediatric Caudal Anesthesia Administration: A National Survey Trial

Öz

Caudal block is the most commonly used regional technique in pediatric anesthesia but very little information is available about clinical practice of applications. The aim of the study is to evaluate a widely used technique caudal block; the experience of the anesthesiologist, applied techniques, the use of drugs and addivies and caudal epidural catheter in Turkey. 553 Anesthesiology and Reanimation expert or research assistant joined the survey after getting the approval of Ethic Committee. A questionnaire form delivered by hand or mail to the relevant people. The majority of participants were expert anesthesiologists, and they generally had a pediatric anesthesia experience <5 years. It was founded that most commonly used needle is 22 or 24 gauge styled caudal needle, the anesthetists considered that the risk of dermoid tissue implantation to the caudal epidural space exists in a high rate, also it was detected that they were using clinical markers for verification of epidural space exists in a high rate. It was founded that bupivacaine 0,125-0,25 % as a local anesthetic was the commonly used drug, opioids were the most frequent drugs as additive. Also caudal catheter usage rates were very low and only sterile gloves were usually used as aseptic technique and that caudal block was usually performed after induction and anesthesia was maintained usually with inhalational anesthesia. Also caudal block was preferred most common in urogenital surgery. In conclusion, a lot of international multicenter studies should be considered to evaluate that used drugs and techniques for the safety of caudal block in pediatric anesthesia.

Anahtar Kelimeler

• Pediatric anesthesia
• caudal block
• caudal anesthesia

Kaynakça

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