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 growing 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. To the extent that regional anesthesia facilitates early tracheal extubation in cardiac surgical patients, complications and costs associated with postoperative mechanical ventilation may be reduced. These benefits must, however, be weighed against the adverse effects that 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 undergoing open heart surgery are reviewed. In addition, specific spinal and epidural techniques currently in use are described, including management of side effects.