Intestinal Reconstruction in Infants Under Epidural Anesthesia Without Invasive Airway: A Prospective Case Study

Background and Aims: This study explored the feasibility of performing intestinal reconstruction after enterostomy in infants using ultrasound-guided epidural anesthesia with sedation, aiming to avoid invasive airway manipulation and the use of opioids. Methods: We included twenty infants scheduled for intestinal reconstruction in this prospective case series. Success was defined by the absence of additional general anesthesia and invasive airway management. The secondary endpoints were the need for additional intraoperative anesthetic and analgesic drugs and postoperative analgesics in the recovery room. The study was approved by the Ethics Commission at the Medical University of Vienna (ref. 1133/2017, approval date 24 August 2017) and registered in the German Clinical Trial Register (DRKS ID: DRKS00012683, approval date 15 July 2019). Results: Nineteen out of twenty procedures were successfully performed with epidural anesthesia under spontaneous breathing and without airway manipulation; one child required endotracheal intubation due to an unexpected, extensive surgical procedure. No child needed systemic analgesics in the recovery room. Conclusions: Epidural anesthesia with sedation can effectively minimize airway manipulation and reduce general anesthesia requirements for intestinal reconstruction in infants.