[Case of spinal anesthesia for pyrolomyotomy in a former preterm infant with chronic lung disease]

A former premature infant (1,795 g) with chronic lung disease underwent pyrolomyotomy under spinal anesthesia. She had been managed with artificial ventilation for 2 months after birth and had developed chronic lung disease. She showed frequent apnea with desaturation several times per day and 21 x min(-1) of oxygen had been administered. She began projectile vomiting 1 month after extubation and then was diagnosed as hypertrophic pyrolic stenosis by ultrasonography. She was transferred to our hospital to have pyrolomyotomy. After admission to pediatric intensive care, she was managed with nasal-DPAP to prevent apnea. Surgery was completed on the second day after admission under spinal anesthesia using 1.0 mg x kg(-1) of hyperbaric bupivacaine. Spinal puncture was accomplished with 19 mm of 27 G needle after removal of lidocaine patch which had been applied 1 hour before. After the outflow of clear CSF was confirmed, the anesthetics was administered. After we confirmed the anesthesia level up to T5, surgery was commenced. She was managed with mask CPAP to prevent deasaturation under spontaneous respiration during surgery. She required nasal-CPAP to prevent apnea after surgery and she was transferred back to the referred hospital on the 3rd postoperative day without any sequela.