Expert: Dr Ian Jackson - please note UK based - 4/4/2004

Question
Thanks Ian,
The child is 7 yrs. old. She had undergone bilateral osteotomies and adductor releases. She came back from the operating theatre with a fentanyl 200 micrograms with ropibucaine 1% 2mls/hr on a continuous epidural infusion at the lumbar site. Her blood pressure went down to 65-69/35. I cannot remember her height. But she is a Cerebral palsy child and wheelchair bound. -------------------------
Followup To
Question -
Is it safe to tilt the head down of a child with epidurals when a blood pressure is low? If yes, for how long? If no, why?
Thanks.
Answer -
Hi there Cielito

I need more information?

Age of child, height that epidural was sited (lumbar, thoracic?)

What has been put down epidural and is an epidural infusion of local anaesthetic running?

Taking best guess at what you are doing then..
If single shot epidural in lumbar region then there should be no problem tilting child head down for as long as necessary for what you or surgeon needs to do.

However

If you are discussing tilting head down because the blood pressure is low (as part of the treatment) then this is not such a good idea. Lift the legs, give fluid and oxygen and give vasoconstrictor if necessary.

Hope this helps.

Answer
Hi again

That gives me more of an idea.

In this situation go with my plan B i.e. don't tilt head down but elevate legs as far as is reasonable, give oxygen and fluids.

Need to assess blood loss and how much replacement. Does she have tachycardia and are her peripheries cold at all?

If yes, and blood loss then need to consider giving colloid instead of clear fluid.

If fluid balance OK then need to consider use of sympathomimetic.

Hope this helps.

Ian