The optimal anaesthetic management of neonates with complete congenital heart block (CCHB) is unknown, as there is a low incidence of such cases. Neonates with CCHB often require surgery for the initiation of electronic pacing. In addition to the challenges of anaesthetising a neonate, this procedure is risky due to the potential for hypotension, arrhythmias and cardiac arrest. We herein present the case of a premature low-birth-weight neonate with antibody-related CCHB and normal heart structure who underwent anaesthesia and surgery for epicardial pacing wire insertion on Day 1 of life. We also compare our patient's anaesthetic conduct and outcome with similar previously reported cases.
Adult ; Anesthetics ; therapeutic use ; Arrhythmias, Cardiac ; prevention & control ; Female ; Heart Block ; congenital ; therapy ; Hemodynamics ; Humans ; Hypotension ; prevention & control ; Infant, Newborn ; Infant, Very Low Birth Weight ; Pacemaker, Artificial ; Treatment Outcome

INTRODUCTIONThere is strong evidence that epidural analgesia provides good postoperative pain relief in adults, but its use in infants is less established. In this retrospective study, we present our experience with managing infant epidural analgesia for abdominal surgeries in a tertiary paediatric institution.

METHODSThe records of 54 infants who had received a thoracic or lumbar epidural as perioperative analgesia for abdominal surgeries were included. The mean age of the infants was 6.1 (standard deviation [SD] 3.8) months and their mean weight was 6.8 kg (SD 1.8). Most (63%) had an ASA (American Society of Anesthesiologists) status of 2 and all underwent elective gastrointestinal, urogenital, hepatobiliary or retroperitoneal surgeries. 20 catheters (37.0%) were inserted in the thoracic region and 33 (61.1%) in the lumbar region.

RESULTSA total of 52 (96.3%) catheters provided adequate intraoperative analgesia and 36 (66.7%) provided effective analgesia for the postoperative period. Active management of epidural analgesia, such as through epidural top-ups and infusion rate adjustment, was necessary to optimise analgesia in 22 (44%) of the 50 patients postoperatively. Reasons for premature catheter removal were mainly technical issues such as catheter disconnection, leakage and blockage.

CONCLUSIONOur data suggests that in experienced hands, specialised settings and active management, the success rate of epidural analgesia in infants undergoing major abdominal surgeries is high and without major incident.

Abdomen ; surgery ; Analgesia ; methods ; Analgesia, Epidural ; methods ; Female ; Humans ; Infant ; Lumbar Vertebrae ; Male ; Pain, Postoperative ; prevention & control ; Pediatrics ; methods ; Perioperative Period ; Retrospective Studies ; Tertiary Care Centers ; Thoracic Vertebrae ; Treatment Outcome