From the Journal archives: Epidural anesthesia in young children: what have we learned in the past 60 years?

UNLABELLED: Francis G. Ruston MD CITATION: Ruston FG. Epidural anaesthesia in infants and children. Can Anaesth Soc J 1954: 1: 37-44.

PURPOSE: The author describes the use of single-shot epidural anesthesia in a series of 44 infants and children. The patients were anesthetized in hospitals in Hamilton, Ontario from 1949 until the time of publication in 1954. The study aimed to describe the indications and efficacy of this technique as well as any apparent complications. A detailed description of the management of these patients was given, including many tips and suggestions that are still applicable in 2013.

PRINCIPAL FINDINGS: Seventy-seven infants and children received epidural anesthesia for a variety of procedures, particularly for pyloric stenosis. Forty-four of the procedures were carried out by the author. All patients survived, apart from one child who died of recurrent intestinal obstruction unrelated to the anesthetic. It was found, after some experience, that the sitting position was preferable for epidural needle insertion. Use of the hanging drop technique for identification of the epidural space proved to be simple and reliable. Surgical conditions were found to be excellent and relaxation was profound; however, some sedation was often required to obtain optimal conditions for surgery. The surgeons became sold on the technique and began to request an epidural on a regular basis.

CONCLUSIONS

Epidural anesthesia in infants and young children is effective for a variety of procedures below the diaphragm, even in moribund patients.