Cardiac effect of pediatric caudal analgesia and holter monitoring

In this study, by adding Holter monitoring to standart cardiac monitoring,the hemodinamic effects due to bupivacaine and caudal block are investigated intwo groups of children having caudal block by equal volumes of bupivacaine inconcentrations 0.25 % and 0.2%.ASA physical status I, aged between 1 and 8 years, undergoingsubumblical surgery (inguinal hernia repair, hydrocele, circumcisition,hypospadias repair, orchiopexy) 60 children were included in this study. Sevenchildren excluded because of inadvertently deleted Holter recordings, after all 53children evaluated in this study. Anesthesia was induced with sevofluraneinhalation ( in 50% O2-air mixture) and following LMA placement O2- air mixturewas adjusted to 40% and MACsevo was maintained 1.3 for 10th minutes. Standartand Holter monitoring was placed, patients received intravenous fluids 4-6mLkg -1. Caudal block was achieved by 0.8 mLkg-1 isobaric bupivacaine in twodifferent concentrations (Group 1 0.25% and Group 2 0.2%). Maximum dose limitwas 2.5 mgkg-1 and maximum volume was 20 mL. After the surgical incisionMACsevo was adjusted to 0.7-0.9. Hemodynamic parameters heart rate, systolicarterial pressure, diastolic arterial pressure, mean arterial pressure, SpO2,MACsevo, EtCO2 and Holter recordings (PR, QRS, RR, QT, QTd, QTc, HRVparamaters) were investigatedDiastolic arterial pressure decreased in 5 to 30 minutes and this effect wasmore prominent in Group 2, no changes were observed in systolic arterial pressureand mean arterial pressure. The QT was longer at 5th min Group 2, but there wasno change in QTd. The QTc was not significantly different in group and betweenthe groups, but it was above the normal values. The HRV parameters resemblingthe autonomic system responses were not significantly different when two groupswere compared. The HRV parameters were less than the normal values and thissituation continued after the cessation of the general anesthesia, which indicatesthe effect of caudal anesthesia.Quality of postoperative analgesia and patient satisfaction were similar intwo groups. Rate and degree of motor block was less in Group 2 (0.2%) thanGroup 1 (0.25%).According to the results of this study, caudal block in children with 0.8mLkg-1, 0.2% bupivacaine, provided effective perioperative and postoperativeanalgesia, minimal motor block, good patient and parent satisfaction. The analysisof PR, QRS, HRV resembled by LF, HF, LFn, HFn, LF/HF shows good preservedthe autonomic maintanance and elongation in QTc shows direct cardiac effect ofbupivacaine.