title: Combined spinal-epidural anesthesia in major abdominal surgery in high-risk neonates and infants.
abstract: 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.
authors: Department of Anesthesia, Bnai Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. somri_m@yahoo.com
authors: Mostafa
authors: M
authors: Somri
authors: Riad
authors: R
authors: Tome
authors: Boris
authors: B
authors: Yanovski
authors: Eldar
authors: E
authors: Asfandiarov
authors: Nurit
authors: N
authors: Carmi
authors: Joerge
authors: J
authors: Mogilner
authors: Bader
authors: B
authors: David
authors: Luis A
authors: LA
authors: Gaitini
mesh_terms: 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