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Spinal anesthesia in 62 premature, former-premature or young infants--technical aspects and pitfalls
Ze'ev Shenkman1, David Hoppenstein, Ita Litmanowitz
1Department of Anesthesia and Critical Care Medicine, Meir Hospital, Kfar Saba, Israel. shlomsh@netvision.net.il
Insights
Spinal anesthesia in infants is feasible with careful technique and monitoring. Key factors for success include preoperative assessment, patient positioning, correct drug dosage, and close intra- and postoperative cardiorespiratory monitoring.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia Techniques
Background:
- Spinal anesthesia (SA) is an option for infant surgeries.
- Technical challenges and potential complications in infants require careful consideration.
Purpose of the Study:
- To outline the technical aspects of performing spinal anesthesia in infants.
- To identify and discuss potential pitfalls associated with infant spinal anesthesia.
Main Methods:
- Retrospective review of medical histories and perioperative courses of infants undergoing SA over 28 months.
- Analysis included patient demographics, co-existing conditions, anesthetic agents, and monitoring data.
Main Results:
- Sixty-two infants, including 55 premature or former-premature, received SA.
- Hyperbaric tetracaine or bupivacaine with adrenaline was used; supplementation or general anesthesia was rarely needed.
- Complication rates (hypoxemia, apnea, bradycardia) were comparable to previous studies.
Conclusions:
- Successful infant spinal anesthesia relies on meticulous preoperative evaluation, precise patient positioning, accurate drug dosing, and vigilant cardiorespiratory monitoring.
- Administration of a relatively high dose of hyperbaric tetracaine or bupivacaine with adrenaline is recommended.
Purpose:
To highlight technical aspects and pitfalls of spinal anesthesia (SA) in infants.
Methods:
The medical history and perioperative course of all infants who underwent SA over a 28-month period were collected (retrospectively in the first 20).
Results:
Sixty-two infants underwent surgery under SA. Fifty-five were premature and former-premature, postconceptional age 43.3 +/- 5.0 weeks, weight 3261 +/- 1243 g. Of these, 21 had co-existing disease: cerebral (six), cardiac (nine), pulmonary (11) and urological (six). Hyperbaric tetracaine or bupivacaine 1 mg x kg(-1) with adrenaline was administered. Four infants (three premature) required N(2)O supplementation and three needed general anesthesia. The supplementation rate was similar or lower than in previous studies. Postoperatively, all seven were shown to have lower limb motor and sensory blockade. Complications in premature patients included intraoperative hypoxemia (two), apnea (two) and bradycardia (one). Postoperative complications included bradycardia (three), hypoxemia (one) and apnea and hypoxemia (one). The postoperative complication rate was similar to previous studies.
Conclusion:
Successful SA in infants depends on close attention to preoperative assessment, appropriate patient positioning during and after lumbar puncture, drug dosing and intra- and postoperative cardiorespiratory monitoring. A relatively high dose of hyperbaric solution of tetracaine or bupivacaine with adrenaline should be administered.