Spinal anesthesia in neonates and infants - a single-center experience of 505 cases.
BACKGROUND
Our aim was to assess the safety and efficacy of spinal anesthesia (SA) in newborns and infants undergoing surgery appropriate for this technique.


METHODS
The files of 505 patients who underwent surgery under spinal anesthesia since 1998 at a major tertiary hospital in Israel were analyzed retrospectively. SA was performed with bupivacaine 5 mgxml(-1) by attending pediatric anesthesiologists or an anesthesia resident. Demographic data, prematurity history, comorbidities, technical data, cardiovascular stability, complications and supplementary drugs were documented. The surgeon assessed the quality of anesthesia at the end of surgery.


RESULTS
Appropriate SA was achieved in 95.3% of cases; in 69.9% at the first attempt. The mean number of attempts per patient was 1.41 and mean dose of bupivacaine was 0.66 +/- 0.16 mgxkg(-1). Intravenous sedation, usually with midazolam (dose 0.1-0.2 mgxkg(-1)) was required in 28.1% of children because of crying/restlessness. Intraoperative conversion to general anesthesia was necessary in five patients (1.04%). The main side effect was bradycardia (<100 bxmin(-1)) without desaturation which occurred in nine patients (1.8%). In three patients (0.62%), high spinal block occurred without bradycardia and hypotension. None of the patients had postoperative meningitis.


CONCLUSIONS
SA is safe and effective in newborns and infants undergoing low abdominal, perineal and orthopedic surgery. In order to save time, our advice is to attempt SA after the surgeon is scrubbed, and minimize surgical teaching activity. The need to deal with a small and sometimes sick patient independent of the type of anesthesia requires the presence of an experienced pediatric anesthesiologist.
Kachko
Ludmyla
L
Department of Anesthesia, Schneider Children's Medical Center of Israel, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. kachko_1@hotmail.com
Simhi
Eliahu
E
Tzeitlin
Elena
E
Efrat
Rachel
R
Tarabikin
Evelina
E
Peled
Elia
E
Metzner
Iulia
I
Katz
Jacob
J
D000775:Anesthesia, Spinal; D000779:Anesthetics, Local; D001049:Apnea / Q000503:physiopathology / Q000628:therapy; D001835:Body Weight; D001919:Bradycardia / Q000139:chemically induced; D002045:Bupivacaine; D005260:Female; D005865:Gestational Age; D006801:Humans; D006993:Hypnotics and Sedatives; D007022:Hypotension / Q000139:chemically induced / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy; D007431:Intraoperative Complications / Q000139:chemically induced / Q000503:physiopathology; D008297:Male; D008874:Midazolam; D011183:Postoperative Complications / Q000139:chemically induced / Q000503:physiopathology; D012189:Retrospective Studies
D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D008874:Midazolam; D002045:Bupivacaine