School of Medicine and Health Sciences Poster Presentations

Title

The Effect of Caudal Anesthesia on Spinal Cord Tissue Oxygenation as Assessed by Tissue Oximetry

Poster Number

169

Document Type

Poster

Publication Date

3-2016

Abstract

Background: During complicated procedures, perfusion to the spinal cord may be compromised, resulting in nerve damage and possible paralysis. Caudal injection of bupivacaine can have effects on mitochondrial oxygen consumption and the sympathetic system, which may increase or decrease spinal cord tissue oxygenation.

Methods: 20 patients up to 2 years of age undergoing surgery receiving a caudal injection of bupivacaine as part of their routine care were studied and compared with 20 patients that did not receive caudal injections for control. Near Infrared Spectroscopy (NIRS) monitor probes were placed on the lumbar region to measure spinal regional saturation (rSO2) and on the forehead to measure cerebral oximetry as a control prior to injection of caudal anesthesia. Measurements of the regional saturations from the probes were recorded every five minutes for a minimum of 25 minutes.

Results: Spinal rSO2 and cerebral rSO2 decreased over 25 minutes from baseline values in both groups. Furthermore, there was a more pronounced decrease in both spinal and cerebral rSO2 in the caudal injection group compared to the control group. In the caudal injection group, cerebral rSO2 decreased significantly (P=0.02); spinal rSO2 also decreased but did not reach clinical significance. There were no significant changes in blood pressure or end tidal CO2.

Conclusion: Caudal injection of bupivacaine decreased spinal cord tissue oxygenation. These results suggest either reduced local blood flow due to vasoconstriction, increased tissue oxygen consumption, or both. There appears to be no difference in immediate physiologic effects. Caudal injection-induced decline in rSO2 could have implications in operative settings with ischemia or poor perfusion. Changes in rSO2 also provide an opportunity to develop NIRS as a non-invasive tool to identify successful caudal injection

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at: GW Research Days 2016

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The Effect of Caudal Anesthesia on Spinal Cord Tissue Oxygenation as Assessed by Tissue Oximetry

Background: During complicated procedures, perfusion to the spinal cord may be compromised, resulting in nerve damage and possible paralysis. Caudal injection of bupivacaine can have effects on mitochondrial oxygen consumption and the sympathetic system, which may increase or decrease spinal cord tissue oxygenation.

Methods: 20 patients up to 2 years of age undergoing surgery receiving a caudal injection of bupivacaine as part of their routine care were studied and compared with 20 patients that did not receive caudal injections for control. Near Infrared Spectroscopy (NIRS) monitor probes were placed on the lumbar region to measure spinal regional saturation (rSO2) and on the forehead to measure cerebral oximetry as a control prior to injection of caudal anesthesia. Measurements of the regional saturations from the probes were recorded every five minutes for a minimum of 25 minutes.

Results: Spinal rSO2 and cerebral rSO2 decreased over 25 minutes from baseline values in both groups. Furthermore, there was a more pronounced decrease in both spinal and cerebral rSO2 in the caudal injection group compared to the control group. In the caudal injection group, cerebral rSO2 decreased significantly (P=0.02); spinal rSO2 also decreased but did not reach clinical significance. There were no significant changes in blood pressure or end tidal CO2.

Conclusion: Caudal injection of bupivacaine decreased spinal cord tissue oxygenation. These results suggest either reduced local blood flow due to vasoconstriction, increased tissue oxygen consumption, or both. There appears to be no difference in immediate physiologic effects. Caudal injection-induced decline in rSO2 could have implications in operative settings with ischemia or poor perfusion. Changes in rSO2 also provide an opportunity to develop NIRS as a non-invasive tool to identify successful caudal injection