High spinal anaesthesia for repair of patent ductus arteriosus in neonates

General anaesthesia with high dose narcotics has traditionally been used for repair of patent ductus arteriosus (PDA) in high risk neonates. Spinal anaesthesia in infants has generally been limited to cases involving the lower abdomen and lower extremities. Regional anaesthesia for PDA repair could potentially offer a more rapid recovery and the possibility of blunting the stress response in this vulnerable group of patients. High spinal anaesthesia with tetracaine was utilized as an alternative to general anaesthesia in a series of fifteen consecutive patients. Patient demographics, medication dosages, level of anaesthesia, intraoperative and immediate postoperative data were obtained and recorded in a prospective fashion. Spinal anaesthesia was achieved in all patients. The average dose of tetracaine was 2.4 mg.kg-1. Two patients early in the series had an inadequate level and received supplemental isoflurane. The remainder of the patients received either no or minimal supplementation to the basic technique. Cardiovascular status of the group was very stable with minimal changes in blood pressure noted. Recovery was rapid. All three patients who were not intubated at the time of surgery were extubated soon after surgical repair was completed. No complications of the technique were noted. High spinal anaesthesia is a safe and effective alternative to general anaesthesia in high risk neonates. This technique may offer the advantage of a faster recovery time and a protective effect on the neonatal stress response. In addition the stability of this technique may encourage the use of higher levels of spinal anaesthesia in infants than has traditionally been used.