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Local anesthetis and adjuvants in pediatric regional anesthesia.
MedLine Citation:
PMID:  22512395     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
The pediatric loco-regional techniques are considered very safe and effective, first of all because they target the therapy directly to the site of surgery, decreasing the risks of intravenous analgesia. The quality of local anesthesia is influenced by structural and biophysical characteristics of local anesthetics drug, dose, site of injection, mixture of local anesthetics and possible addition of a vasoconstrictor or an adjuvant to prolong the analgesic effect. In children, unlike adults, small nerve diameters and short distance between Ranvier nodes permit to use large volumes and low concentrations of local anesthetics. The clinical practice have showed that in pediatric population effective analgesia is obtained by 1% mepivacaine, 1% lidocaine and 0.25% bupivacaine or better 0.2% ropivacaine, 0.2-0.25% levobupivacaine. In addition emerges that levobupivacaine and ropivacaine have a better profile in terms of safety in comparison to bupivacaine and are the local anesthetics of choice for the daily clinical practice also in children as in adults. Among the adjuvant, clonidine and ketamine showed the best pharmacokinetic and pharmacodynamic profiles of effective and safety, improving and prolonging the action of associated local anesthetics. So the use of enantiomers, in association with adjuvants as clonidine or ketamine, using the multimodal approach of integrated anesthesia, makes effective and safe the clinical practice in the pediatric operating rooms. This review focuses on the overview of local anesthetics and adjuvants used for today in locoregional pediatric anesthesia, with an emphasis on the advantages and disadvantages of each drugs.
Authors:
Valeria Mossetti; Noemi Vicchio; Giorgio Ivani
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-18
Journal Detail:
Title:  Current drug targets     Volume:  -     ISSN:  1873-5592     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100960531     Medline TA:  Curr Drug Targets     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Pediatric Anesthesiology and Intensive Care, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin Italy. gioivani@libero.it.
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