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Combined spinal-epidural anesthesia in major abdominal surgery in high-risk neonates and infants

Mostafa Somri1, Riad Tome, Boris Yanovski

  • 1Department of Anesthesia, Bnai Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. somri_m@yahoo.com

Paediatric Anaesthesia
|September 28, 2007
PubMed

Insights

Combined spinal-epidural anesthesia (CSE-A) offers effective anesthesia for major upper abdominal surgeries in neonates and infants. While generally safe, some patients required conversion to general anesthesia or additional sedation and ventilation support.

Area of Science:

  • Pediatric Anesthesiology
  • Regional Anesthesia Techniques
  • Surgical Anesthesia

Background:

  • Combined spinal-epidural anesthesia (CSE-A) is recognized for its safety and efficacy in pediatric infraumbilical surgeries.
  • This study aimed to evaluate CSE-A in neonates and infants undergoing major upper abdominal procedures.

Purpose of the Study:

  • To describe the experience and outcomes of using CSE-A in neonates and infants for elective major upper abdominal surgery.
  • To assess the effectiveness and safety of CSE-A in this specific patient population.

Main Methods:

  • Twenty-eight neonates and infants received spinal anesthesia with isobaric bupivacaine followed by caudal epidural catheter placement.
  • Radiographic confirmation of catheter position was performed.
  • Respiratory and hemodynamic data were monitored, and complications were recorded.

Main Results:

  • Successful surgical anesthesia was achieved in 24 patients; four required conversion to general anesthesia.
  • No significant changes in oxygen saturation, blood pressure, heart rate, or respiratory rate were observed.
  • Twenty infants experienced fussiness, necessitating midazolam sedation, oxygen supplementation, and transient manual ventilation.

Conclusions:

  • CSE-A can be considered an effective anesthetic option for awake or sedated neonates and infants undergoing major upper abdominal surgery.
  • Pediatric anesthesiologists may cautiously use CSE-A as an alternative to general anesthesia, particularly in high-risk infants undergoing upper gastrointestinal surgery.
Abstract

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