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Correspondence  |   September 2002
Hemodynamic Stability after Pediatric Epidurals
Author Affiliations & Notes
  • Jacques E. Chelly, M.D., Ph.D., M.B.A.
    *
  • *The University of Texas Health Science Center at Houston, Houston, Texas.
Article Information
Correspondence
Correspondence   |   September 2002
Hemodynamic Stability after Pediatric Epidurals
Anesthesiology 9 2002, Vol.97, 762. doi:
Anesthesiology 9 2002, Vol.97, 762. doi:
We would like to thank Dr. Rebecca Lowery for her interest in our case report. The quote to which Dr. Lowery referred was only half of our original sentence, which read “The absence of epidural spread was assessed by hemodynamic stability after the performance of the blocks and  by the presence of an adequate reaction to pin prick of the opposite leg after emergence.” Although we also recognize that the hemodynamic changes associated with neuroaxial blockade may be absent or less pronounced in infants and young children, it is critical to acknowledge also the following. (1) Dohi et al.  1 and Oberlander et al.  2 reported on a very limited number of infants and young children. Although Dohi et al.  1 reported that significant hypotension might be observed in young children around 5 yr of age and older, extrapolating from these articles, the concept that 5 yr represents the absolute lower limit for children to be exposed to such risk following a neuroaxial block may be excessive. (2) More importantly, in infants and young children, any diagnosis is often the result of the convergence of symptoms, and therefore, even if the risk is minimum, it should not be ignored. (3) We would like to believe that Dr. Lowery is not recommending not monitoring blood pressure following the performance of lumbar plexus block in infants and young children. In conclusion, we are happy to have provided an opportunity for Dr. Lowery to remind us about the expected hemodynamic changes associated with neuroaxial blocks in infants and young children. However, we would like to maintain that monitoring blood pressure is essential when performing a lumbar plexus block, even in this patient population.
References
Dohi S, Natio H, Takahashi T: Age-related changes in blood pressure and duration of motor block in spinal anesthesia. A nesthesiology 1999; 50: 319–23Dohi, S Natio, H Takahashi, T
Oberlander TF, Berde CB, Lam KH, Rappaport LA, Saul JP: Infants tolerate spinal anesthesia with minimal overall autonomic changes: Analysis of heart rate variability in former premature infants undergoing hernia repair. Anesth Analg 1995; 80: 20–7Oberlander, TF Berde, CB Lam, KH Rappaport, LA Saul, JP