Spinal anesthesia for diagnostic cardiac catheterization in high-risk infants.
BACKGROUND
The main goals of diagnostic cardiac catheterization (DCC) in infants are to evaluate the anatomy and physiology of congenital and acquired cardiac defects while maintaining normal respiratory and hemodynamic variables. The aims of anesthesia for infants undergoing DCC are to prevent pain and movement during the procedure. General anesthesia (GA) or deep sedation could have undesirable respiratory and hemodynamic effects for conducting such studies. Furthermore, GA is associated with increased risks, especially in high-risk infants. Spinal anesthesia (SA) is a successful alternative to GA in surgery on infants with a history of prematurity and respiratory problems, with minimal respiratory and hemodynamic changes.


METHODS
We studied whether those advantages were applicable to DCC, and used a predetermined SA protocol in a cohort of 12 infants with compromised respiratory status. Success rate, study completion, complications, hemodynamic and respiratory effects and recovery profile were recorded.


RESULTS
Failure rate was significantly higher in infants older than 6 months. There was no significant difference between baseline and intraprocedure hemodynamic and respiratory parameters. The time to discharge was relatively short (33 +/- 12 min).


CONCLUSIONS
Spinal anesthesia apparently provides stable hemodynamics and respiratory variables, rapid recovery and discharge time, and may be a viable alternative to GA or deep sedation in high-risk infants <6 months old undergoing DCC.
Katznelson
Rita
R
Pediatric Anesthesia Division, Department of Anesthesia and Intensive Care, Sheab Medical Center, Tel Hashomer 52621, Israel.
Mishaly
David
D
Hegesh
Theodor
T
Perel
Azriel
A
Keidan
Ilan
I
D000775:Anesthesia, Spinal; D006328:Cardiac Catheterization / Q000379:methods*; D002675:Child, Preschool; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis; D006439:Hemodynamics / Q000502:physiology; D006552:Hernia, Inguinal; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D015656:Respiratory Mechanics / Q000502:physiology; D012140:Respiratory Tract Diseases / Q000150:complications / Q000151:congenital; D012306:Risk