Neonatal regional anesthesia: alternative to general anesthesia for urologic surgery

The physiologic immaturity of respiratory musculature and central respiratory control centers leads to an increased risk of apnea and respiratory complications following general anesthesia in the neonate. Regional anesthetic techniques such as spinal and caudal epidural anesthesia may obviate the need for general anesthesia and lessen the risks of perioperative morbidity. Although these techniques have been previously described in infants, the majority of reports focus on regional anesthesia during herniorrhaphy in the former, preterm infant. There is relatively little or no information concerning regional anesthesia during urologic surgery in infants, especially during the actual neonatal period (0 to 28 days). We report on three neonates (2.17 to 3.8 kg) who required anesthetic care during the neonatal period for various urologic procedures including cystoscopy, incision of a ureterocele, and vesicostomy placement. Either caudal or spinal anesthesia was successfully used in the awake infant without the need for supplemental anesthetic agents (intravenous or inhalational). The advantages, risks, and applications of regional anesthesia during urologic surgery in the neonate are reviewed.