[Spinal anesthesia for surgery of inguinal hernia in infants at risk for respiratory complications. Initial experiences with 12 patients].
11 former premature babies born at a mean gestational age of 32 weeks (range 27-34 weeks) and one baby born at term with congenital diaphragmatic hernia scheduled for inguinal hernia repair were selected to receive a spinal anaesthesia after informed written consent was obtained from one of the parents. At birth, 10 infants were intubated and received assisted ventilation; the remaining two were on nasal CPAP for 24 hours after birth. The mean post-conceptual age of the former premature infants on the day of surgery was 39 weeks (range 36-43 weeks), the mean weight was 2.2 kg (range 1.8 to 3.6 kg). One boy with congenital diaphragmatic hernia who was intubated for 19 days after birth aged 4 months on the day of operation and weighed 5.3 kg. None of the children was oxygen-dependent on the day of surgery. Spinal anaesthesia was performed in 3 children in the lateral decubitus and in 9 children in the sitting position. In each group, there was one case when spinal anaesthesia could not be performed due to a bloody spinal tap. These children received general anaesthesia, one of them in combination with a caudal block. The 9 former premature received 0.6 ml isobaric bupivacaine 0.5%, and the child born on term with diaphragmatic hernia 0.8 ml isobaric bupivacaine 0.5%. The onset of the motor blockade in the former preterm infants was within 60-90 seconds, while in the older child the onset was 10 minutes. With the given dose, the operation could be performed without any problems.(ABSTRACT TRUNCATED AT 250 WORDS)
Fösel
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Klinik für Anästhesiologie und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg.
Larsen
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Schwaiger
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D000775:Anesthesia, Spinal; D005865:Gestational Age; D006552:Hernia, Inguinal / Q000151:congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology*; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology*; D012307:Risk Factors
Spinalanästhesie zur Operation von Leistenhernien bei respiratorisch gefährdeten Säuglingen. Erste Erfahrungen bei 12 Patienten.