[Lumbar epidural anesthesia in a very-low-birth-weight infant]

In this case study two combined, light-general and lumbar epidural anesthetics were administered to a premature neonate for the repair of gastroschisis. The female infant's body weight was 1400 grams (first operation) and 1700 grams (second operation). The epidural catheter was inserted between the low-lumbar vertebrae using the "loss of resistance" for saline technique. Intra- and postoperative analgesia were based on epidural administration of bupivacaine and fentanyl. No systemic opioids were administered. The infant recovered from general anesthesia at the end of both operations. Excellent analgesia was accomplished throughout the peri-operative course except for short periods during and after the second operation that resolved after the epidural catheter was withdrawn by a few centimeters. Neither respiratory or hemodynamic depression, nor bupivacaine toxicity were observed. The anesthetic and analgesic management is presented in the article. Technical aspects of lumbar epidural anesthesia, it's advantages over the caudal approach and dosages of epidural anesthetics in small infants, as well as complications and risks are emphasized.