• Adam C Adler, Donald A Schwartz, Annemarie Begley, Jennifer Friderici, and Neil Roy Connelly.
• Department of Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
• Paediatr Anaesth. 2015 Dec 1; 25 (12): 1274-9.

IntroductionPrevious studies identified decreasing heart rate (HR) as a predictor of successful caudal placement in children using halothane and isoflurane. No changes were found in HR in the one study using sevoflurane. We documented HR changes in children following a caudal block during sevoflurane anesthesia utilizing ultrasound to confirm successful caudal placement.MethodsSeventy-one children (1-82 months) were anesthetized with sevoflurane. A caudal block was placed with confirmation by ultrasound. Four aliquots of bupivacaine 0.2% with epinephrine 5 μg · cc(-1) were administered for a total volume of 1 cc · kg(-1) with HR recorded for 4 min. The outcomes measured were HR changes from the initial baseline and during each 1-min interval. The age-related differences in HR were also analyzed.ResultsHeart rate change from the initial baseline after placing the caudal needle and allowing for equilibration ranged from -10.2% to +8.9% and the HR change from the baseline at the start of each aliquot injection ranged from -9.5% to +8.9%. Most participants (n = 60, 84.5%) experienced at least one HR reduction over the observation period. For patients < 36 months, the HR change ranged from -11 to +12 b · min(-1) (mean -0.3); for patients aged ≥ 36 months, the HR change ranged from -10 to +6 b · min(-1) (mean -1.1).ConclusionsHeart rate changes following a caudal block in children ≤ 82 months of age anesthetized with sevoflurane is not a reliable indicator of a successful block. Despite 100% caudal success, many children had no decrease in HR, and in those that did, the decline was of a magnitude indeterminate from beat-to-beat variability.© 2015 John Wiley & Sons Ltd.

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