title: Spinal anesthesia in 62 premature, former-premature or young infants--technical aspects and pitfalls.
abstract: 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.
authors.affiliation: Department of Anesthesia and Critical Care Medicine, Meir Hospital, Kfar Saba, Israel. shlomsh@netvision.net.il
authors.forename: Ze'ev
authors.initials: Z
authors.lastname: Shenkman
authors.forename: David
authors.initials: D
authors.lastname: Hoppenstein
authors.forename: Ita
authors.initials: I
authors.lastname: Litmanowitz
authors.forename: Shy
authors.initials: S
authors.lastname: Shorer
authors.forename: Michael
authors.initials: M
authors.lastname: Gutermacher
authors.forename: Ludvig
authors.initials: L
authors.lastname: Lazar
authors.forename: Ilan
authors.initials: I
authors.lastname: Erez
authors.forename: Robert
authors.initials: R
authors.lastname: Jedeikin
authors.forename: Enrique
authors.initials: E
authors.lastname: Freud
mesh_terms: 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