Combined spinal-epidural anesthesia in major abdominal surgery in high-risk neonates and infants.
BACKGROUND
Combined spinal-epidural anesthesia (CSE-A) is reportedly safe and effective for the pediatric population in infraumbilical surgery. Our main purpose was to describe our experience of this technique in neonates and infants undergoing elective major upper abdominal surgery.


METHODS
Spinal anesthesia was performed in 28 neonates and infants with isobaric bupivacaine 0.5%, 1 mg.kg(-1) followed by placement of a caudal epidural catheter to thoracic spinal segments. The catheter tip position was confirmed radiographically. Respiratory and hemodynamic data were collected before and after the CSE-A and throughout the operation, as a measure of anesthetic effectiveness. Complications related to the anesthesia technique were collected as a measure of the anesthetic technique safety.


RESULTS
Satisfactory surgical anesthesia was achieved in 24 neonates and infants, four patients were converted to general anesthesia. Respiratory and hemodynamic variables did not change significantly during surgery, compared with baseline values: oxygen saturation (P = 0.07), systolic and diastolic blood pressures (P = 0.143, P = 0.198 respectively), heart rate (P = 0.080) and respiratory rate (P = 0.127). However, twenty infants were fussy during the surgical procedures and were calmed with intravenous midazolam; our patients required oxygen supplementation and transient manual ventilation intraoperatively.


CONCLUSIONS
Combined spinal-epidural anesthesia could be considered as an effective anesthetic technique for elective major upper abdominal surgery in awake or sedated neonates and infants, and could be used cautiously by a pediatric anesthesiologist as an alternate to general anesthesia in high-risk neonates and infants undergoing upper gastrointestinal surgery.
Somri
Mostafa
M
Department of Anesthesia, Bnai Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. somri_m@yahoo.com
Tome
Riad
R
Yanovski
Boris
B
Asfandiarov
Eldar
E
Carmi
Nurit
N
Mogilner
Joerge
J
David
Bader
B
Gaitini
Luis A
LA
D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects; D013505:Digestive System Surgical Procedures / Q000145:classification; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic; D010043:Outcome and Process Assessment, Health Care; D012307:Risk Factors; D013997:Time Factors