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

Abstract:

PURPOSE:Spinal anesthesia (SA) is being increasingly used in infants to avoid the potential negative neurocognitive effects of general anesthesia (GA). However, SA has been reported to provide a relatively short duration of surgical anesthesia. METHODS:We retrospectively reviewed SA cases for surgical procedures lasting more than 60 min in children up to 3 years old. All patients received bupivacaine 0.5% (1 mg/kg up to 7 mg) with clonidine 1 µg/kg ± epinephrine. The primary outcome was success of SA without subsequent conversion to GA. RESULTS:Thirty-five patients met inclusion criteria (all males, age 7 ± 5 months, weight 8 ± 2 kg). Procedures included male genital, groin and multiple site surgeries. Average surgical duration was 71 ± 12 min (range 60-111 min). SA was successful in 31 of 35 patients (89%; 95% confidence interval 78, 99%). The cause of failure was rarely due to the duration of surgery (1 of 4 patients). Six patients with successful SA required sedation with dexmedetomidine ± fentanyl. Differences in procedure duration and patient characteristics were not statistically significant between successful and failed SA. CONCLUSIONS:SA is a highly successful technique and may offer an alternative to GA in children undergoing appropriate surgery expected to last as long as 60-100 min.

journal_name

J Anesth

journal_title

Journal of anesthesia

authors

Trifa M,Tumin D,Whitaker EE,Bhalla T,Jayanthi VR,Tobias JD

doi

10.1007/s00540-018-2517-5

subject

Has Abstract

pub_date

2018-08-01 00:00:00

pages

637-640

issue

4

eissn

0913-8668

issn

1438-8359

pii

10.1007/s00540-018-2517-5

journal_volume

32

pub_type

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