Chapter 43. Peripheral Nerve Blocks for Children
Levobupivacaine 0.2% at 1 mL/kg in a single shot caudal without any additive is used for hypospadias surgery. What advantage did the 0.2% concentration have over the 0.25% concentration?
B. Shorter discharge time
C. Lower incidence of cardiac toxicity
D. Decreased motor weakness
D is correct. When caudal is used for analgesic purposes, motor block is not necessary and may worry caregivers in the post-anesthesia care unit even though risk of complications is extremely low.1
Neonatal spinal anesthesia supplemented with dexmedetomidine most often results in:
A. Less conversion to general anesthesia
B. Hemodynamic instability
C. Slower discharge from PACU
D. Shorter surgery duration
A is correct. Dexmedetomidine enhances regional anesthesia blockade and deepens anesthesia, so when the block begins to wear off, sedative effects remain.2
A 1-month-old former 32-week gestation male infant is scheduled for an inguinal hernia repair. How does practitioner level (attending/CRNA/resident) matter in terms of success/failure of placement of an infant spinal?
A. Spinal success rate is similar for all practitioner types.
B. Attendings have as much as 10–15 times lower failure rate than residents.
C. In order of highest success rate: attending > resident > CRNA.
D. Ability to obtain CSF flow is similar with all practitioners.
B is correct. Infant spinal requires training and experience. It is more difficult than performing an adult spinal anesthetic and the perioperative management is very different. Consideration for who does the first attempt should be made if spinal is particularly important in the infant.3,4
Local anesthetic drug dosage in neonates compared to adults should be:
A. Increased due to higher glomerular filtration
B. Adjusted downward due to lower α1-acid glycoprotein levels
C. Increased because of larger weight-based blood volume
B is correct. Peripheral nerve block dose should be adjusted to account for hepatorenal differences in neonates.5