Spinal anesthesia in 62 premature, former-premature or young infants--technical aspects and pitfalls.
OBJECTIVE
To highlight technical aspects and pitfalls of spinal anesthesia (SA) in infants.


METHODS
The medical history and perioperative course of all infants who underwent SA over a 28-month period were collected (retrospectively in the first 20).


RESULTS
Sixty-two infants underwent surgery under SA. Fifty-five were premature and former-premature, postconceptional age 43.3 +/- 5.0 weeks, weight 3261 +/- 1243 g. Of these, 21 had co-existing disease: cerebral (six), cardiac (nine), pulmonary (11) and urological (six). Hyperbaric tetracaine or bupivacaine 1 mg x kg(-1) with adrenaline was administered. Four infants (three premature) required N(2)O supplementation and three needed general anesthesia. The supplementation rate was similar or lower than in previous studies. Postoperatively, all seven were shown to have lower limb motor and sensory blockade. Complications in premature patients included intraoperative hypoxemia (two), apnea (two) and bradycardia (one). Postoperative complications included bradycardia (three), hypoxemia (one) and apnea and hypoxemia (one). The postoperative complication rate was similar to previous studies.


CONCLUSIONS
Successful SA in infants depends on close attention to preoperative assessment, appropriate patient positioning during and after lumbar puncture, drug dosing and intra- and postoperative cardiorespiratory monitoring. A relatively high dose of hyperbaric solution of tetracaine or bupivacaine with adrenaline should be administered.
Shenkman
Ze'ev
Z
Department of Anesthesia and Critical Care Medicine, Meir Hospital, Kfar Saba, Israel. shlomsh@netvision.net.il
Hoppenstein
David
D
Litmanowitz
Ita
I
Shorer
Shy
S
Gutermacher
Michael
M
Lazar
Ludvig
L
Erez
Ilan
I
Jedeikin
Robert
R
Freud
Enrique
E
D000775:Anesthesia, Spinal / Q000379:methods*; D001049:Apnea / Q000209:etiology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D011183:Postoperative Complications / Q000209:etiology