• Christiane E Beck, Robert Sümpelmann, Katja Nickel, Oliver Keil, Jochen F Kuebler, Dietmar Boethig, Lars Witt, and Nils Dennhardt.
• From the Clinic of Anaesthesiology (CEB, RS, KN, OK, LW, ND), Clinic for Paediatric Surgery (JFK), Department for Paediatric Cardiology and Intensive Care, Hannover Medical School, Hannover (DB) and Clinic of Anaesthesiology, KRH Klinikum Robert Koch, Gehrden, Germany (LW).
• Eur J Anaesthesiol. 2020 Aug 1; 37 (8): 696-700.

BackgroundInfants undergoing general anaesthesia have an increased risk of severe respiratory and cardiovascular critical events. Awake caudal anaesthesia is an alternative for small infants undergoing minor lower abdominal surgery. While clinical experience has shown stable intra-operative haemodynamic conditions, there are no studies evaluating systemic and regional cerebral perfusion during such a procedure.ObjectivesThe purpose of this study was to evaluate the effects of awake caudal anaesthesia on systemic and regional cerebral perfusion in small infants.DesignA prospective observational cohort study.SettingClinic of Anaesthesiology, University Children's Hospital, between November 2017 and June 2018.PatientsTwenty small infants (postmenstrual age 36 to 54 weeks, weight 1800 to 5700 g) scheduled for lower abdominal surgery under awake caudal anaesthesia were enrolled in this study.InterventionStandard monitoring was expanded to include cardiac index using electrical velocimetry and regional cerebral oxygen saturation using near infrared spectroscopy. The caudal block was performed with 0.3% ropivacaine 1 ml kg Hypotension was defined as mean arterial blood pressure (BP) less than 35 mmHg and regional cerebral desaturation as regional cerebral oxygen saturation less than 80% of baseline.Main OutcomesMean arterial BP, cardiac index and regional cerebral oxygen saturation parameters under awake caudal anaesthesia.ResultsMean arterial BP, cardiac index and regional cerebral oxygen saturation remained above the predefined lower limits. No episodes of hypotension or regional cerebral desaturation were observed. Operation time was 35 ± 13 (range 20 to 71) min. The infants were discharged to the neonatal ward after the end of surgery, and milk was fed 22 ± 15 (range 6 to 55) min thereafter. Five preterm infants experienced self-limiting episodes of apnoea intra-operatively.ConclusionThe current study shows that awake caudal anaesthesia does not impair systemic and regional cerebral perfusion in small infants.Trial RegistrationGerman registry of clinical studies (DRKS-ID: 800015742).

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