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Apnoea in a former preterm infant after caudal bupivacaine with clonidine for inguinal herniorrhaphy

Claudia Fellmann1, Andreas C Gerber, Markus Weiss

  • 1Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland. claudia.fellmann@kispi.unizh.ch

Paediatric Anaesthesia
|October 3, 2002
PubMed

Insights

Awake caudal anesthesia using bupivacaine and clonidine in former preterm infants may cause respiratory complications like apneas. Careful dose and drug selection are crucial for safe anesthesia in this vulnerable population.

Area of Science:

  • Pediatric Anesthesiology
  • Neonatal Surgery

Background:

  • General anesthesia in former preterm infants for inguinal hernia repair carries risks of respiratory complications.
  • Awake regional anesthesia, specifically caudal anesthesia, is an alternative to mitigate these risks.
  • Caudal clonidine is explored to extend anesthesia duration and reduce postoperative pain.

Observation:

  • A case report details two caudal anesthetics in a former preterm infant within three weeks.
  • The first procedure at 35 weeks postconceptional age, using bupivacaine 0.25%, was uneventful.
  • The second procedure at 38 weeks, with bupivacaine 0.125% and clonidine, resulted in intra- and postoperative apneas.

Findings:

  • Inadvertent administration of a lower concentration of bupivacaine combined with clonidine led to significant respiratory events (apneas).
  • This case highlights potential risks associated with caudal clonidine, even at reduced bupivacaine concentrations, in former preterm infants.
  • The safety profile of caudal clonidine in this population warrants further investigation.

Implications:

  • Clinicians should exercise extreme caution when using caudal clonidine in former preterm infants undergoing surgery.
  • Dosage and drug combinations need careful consideration to avoid adverse respiratory events.
  • Further research is necessary to establish safe and effective anesthetic protocols for this high-risk group.

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