The use of regional anesthesia in combination with general anesthesia for cardiac surgery in children

The use of regional anesthesia in combination with general anesthesia for children undergoing cardiac surgery is the subject of a number of publications and presentations. Benefits of regional anesthesia in patients having cardiac surgery include attenuation of the neuroendocrine response to surgical stress, improved postoperative pulmonary function, enhanced cardiovascular stability, and improved postoperative analgesia. Regional anesthesia can control adverse cardiovascular reflexes in cardiac surgical patients and may facilitate early tracheal extubation, thereby reducing complications and costs associated with postoperative mechanical ventilation. These benefits must, however, be weighed against the adverse effects which may accompany the use of regional anesthesia, including hypotension, postoperative respiratory depression, and epidural hematoma formation. In this article, the benefits and risks of regional anesthesia in infants and children having open heart surgery are reviewed. In addition, specific spinal and epidural techniques currently in use are described, including management of side effects.