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首页> 外文期刊>Current opinion in anaesthesiology >The caudal catheter in neonates: Where are the restrictions?
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The caudal catheter in neonates: Where are the restrictions?

机译：新生儿的尾管：限制在哪里？

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Purpose of review: In neonates, epidural catheters inserted at the sacral hiatus can easily be advanced to a lumbar or thoracic level. These 'caudal catheters' are popular because they allow the neonate to benefit from epidural analgesia without the concerns of spinal cord injury potentially associated with primary thoracic placement in an asleep neonate. This review looks at use and benefits, and risks and complications of caudal epidural catheters in neonates. Recent findings: Restrictions of neonatal caudal catheters are related to risks associated with placement and advancement of the catheters, infectious risks of caudal catheters, and toxicity risks related to the higher free fraction and lower clearance of bupivacaine in neonates. Caudal catheters in neonates are popular, but evidence that they improve outcome is lacking. Summary: Epidural anesthesia and analgesia for neonates should be performed and managed by pediatric anesthesiologists. Potential risks and complications must be appreciated and all steps to maximize safety of the technique must be taken. In particular, close postoperative observation and pain service management are indispensable. Future research should investigate the risks of caudal and segmentally placed catheters in neonates, study the role of epidural analgesia in outcome improvement for neonates, and guide us to safer use of local anesthetics suitable for neonates with their pharmacologic immaturity.
机译：审查目的：在新生儿中，在inserted裂处插入的硬膜外导管可轻松推进至腰椎或胸廓水平。这些“尾导管”之所以流行，是因为它们使新生儿受益于硬膜外镇痛，而无需担心可能与熟睡的新生儿原发性胸腔放置相关的脊髓损伤。这篇综述探讨了新生儿尾椎硬膜外导管的使用和益处以及风险和并发症。最新发现：新生儿尾管的局限性与导管放置和前进相关的风险，尾管的传染性风险以及新生儿中布比卡因的游离分数较高和清除率较低相关的毒性风险。新生儿中的尾管很普遍，但缺乏能改善结局的证据。简介：新生儿的硬膜外麻醉和镇痛应由儿科麻醉师进行和管理。必须意识到潜在的风险和复杂性，必须采取使该技术最大化安全性的所有步骤。特别地，术后密切观察和疼痛服务管理是必不可少的。未来的研究应该调查新生儿尾管和分段放置导管的风险，研究硬膜外镇痛在新生儿结局改善中的作用，并指导我们更安全地使用适合新生儿的局部麻醉药，因为它们的药理学上不成熟。

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