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Spinal anesthesia for surgery longer than 60 min in infants: experience from the first 2 years of a spinal anesthesia

Mehdi Trifa1,2, Dmitry Tumin3, Emmett E Whitaker3,4

  • 1Department of Anesthesiology, Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. mehditrifa@gmail.com.

Journal of Anesthesia
|May 30, 2018
PubMed

Insights

Spinal anesthesia (SA) is a successful alternative to general anesthesia (GA) in infants for surgeries up to 100 minutes. This study found SA effective in 89% of pediatric cases, offering a safer option for young children.

Area of Science:

  • Pediatric Anesthesiology
  • Regional Anesthesia Techniques
  • Neurodevelopmental Outcomes

Background:

  • General anesthesia (GA) may negatively impact neurocognitive development in infants.
  • Spinal anesthesia (SA) is an emerging alternative to GA for pediatric procedures.
  • SA's duration has been a limitation for longer surgeries.

Purpose of the Study:

  • To evaluate the success rate of spinal anesthesia (SA) for pediatric surgical procedures exceeding 60 minutes.
  • To determine if SA can provide adequate anesthesia duration for extended surgeries in children up to 3 years old.
  • To assess SA as a viable alternative to GA, minimizing potential neurocognitive risks.

Main Methods:

  • Retrospective review of pediatric patients (up to 3 years) undergoing surgery >60 minutes under SA.
  • SA involved bupivacaine 0.5% (1 mg/kg, max 7 mg) with clonidine and epinephrine.
  • Primary outcome: successful SA without conversion to GA; secondary: need for sedation.

Main Results:

  • 35 male infants (mean age 7 months, weight 8 kg) met inclusion criteria.
  • Average surgical duration was 71 minutes (range 60-111 minutes).
  • SA success rate was 89% (31/35), with failure rarely due to insufficient duration. Six patients required additional sedation.

Conclusions:

  • Spinal anesthesia (SA) demonstrates high success rates (89%) for pediatric surgeries lasting up to 100 minutes.
  • SA is a viable alternative to GA in children for appropriate surgical procedures.
  • Further research can explore optimizing SA for extended durations and diverse pediatric populations.
Abstract

Keywords:
ChildrenClonidineEpinephrineSpinal anesthesia

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