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[Spinal anesthesia for surgery of inguinal hernia in infants at risk for respiratory complications. Initial
T Fösel1, R Larsen, C Schwaiger
1Klinik für Anästhesiologie und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg.
Insights
Spinal anesthesia is a safe and effective option for former premature infants and a term infant undergoing inguinal hernia repair. This technique allowed for successful surgeries with rapid onset of motor blockade, demonstrating its utility in pediatric anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia Techniques
- Neonatal Surgery
Context:
- Evaluating spinal anesthesia in a cohort of former premature infants and one term infant with congenital diaphragmatic hernia.
- Assessing feasibility and efficacy for inguinal hernia repair.
- Patients included former premature infants (mean gestational age 32 weeks) and a term infant requiring surgical intervention.
Purpose:
- To determine the safety and effectiveness of spinal anesthesia in former premature infants and a term infant undergoing inguinal hernia repair.
- To document the onset of motor blockade and procedural success rates.
- To evaluate the use of isobaric bupivacaine for spinal anesthesia in this specific pediatric population.
Summary:
- Spinal anesthesia was successfully administered to 11 former premature infants and 1 term infant for inguinal hernia repair.
- Onset of motor blockade was rapid (60-90 seconds) in former preterm infants and 10 minutes in the term infant.
- The procedure was completed successfully in all cases where spinal anesthesia was feasible, with appropriate dosing of isobaric bupivacaine.
Impact:
- Demonstrates the viability of spinal anesthesia as a primary anesthetic technique in former premature infants for elective procedures.
- Provides data on bupivacaine dosing and onset of action in a specialized pediatric group.
- Highlights the importance of careful patient selection and technique for successful regional anesthesia in neonates and infants.
Abstract:
11 former premature babies born at a mean gestational age of 32 weeks (range 27-34 weeks) and one baby born at term with congenital diaphragmatic hernia scheduled for inguinal hernia repair were selected to receive a spinal anaesthesia after informed written consent was obtained from one of the parents. At birth, 10 infants were intubated and received assisted ventilation; the remaining two were on nasal CPAP for 24 hours after birth. The mean post-conceptual age of the former premature infants on the day of surgery was 39 weeks (range 36-43 weeks), the mean weight was 2.2 kg (range 1.8 to 3.6 kg). One boy with congenital diaphragmatic hernia who was intubated for 19 days after birth aged 4 months on the day of operation and weighed 5.3 kg. None of the children was oxygen-dependent on the day of surgery. Spinal anaesthesia was performed in 3 children in the lateral decubitus and in 9 children in the sitting position. In each group, there was one case when spinal anaesthesia could not be performed due to a bloody spinal tap. These children received general anaesthesia, one of them in combination with a caudal block. The 9 former premature received 0.6 ml isobaric bupivacaine 0.5%, and the child born on term with diaphragmatic hernia 0.8 ml isobaric bupivacaine 0.5%. The onset of the motor blockade in the former preterm infants was within 60-90 seconds, while in the older child the onset was 10 minutes. With the given dose, the operation could be performed without any problems.(ABSTRACT TRUNCATED AT 250 WORDS)