title: Hemodynamic changes during spinal anesthesia in premature infants with congenital heart disease undergoing inguinal hernia correction.
abstract: BACKGROUND
  There are conflicting reports on the effects of spinal anesthesia (SA) on hemodynamics. Data on the hemodynamic effects of SA in infants with congenital heart disease (CHD) are limited.
  
  
  METHODS
  We reviewed our experience with 44 unsupplemented SA with 1 mg·kg(-1) of either hyperbaric tetracaine or bupivacaine in premature and former premature infants with noncyanotic CHD. Hemodynamics and oxyhemoglobin saturation (SpO(2)) were assessed. Neither preoperative fluid boluses nor atropine was administered to any of the infants.
  
  
  RESULTS
  There was no significant change in systolic, diastolic, or mean blood pressures from pre-SA induction compared with end of surgery. Heart rate showed a small but systematic decline (mean change of 10 beats per minute, P < 0.01) but was within the normative range values for age. There was a small, but clinically insignificant increase in SpO(2) across the time course. Intraoperatively, two infants developed transient apneic spells. No infant developed postoperative apnea, oxygen desaturation, or bradycardia.
  
  
  CONCLUSIONS
  The data suggest that SA with 1 mg·kg(-1) of either hyperbaric tetracaine or bupivacaine can be used safely as the sole anesthetic for inguinal hernia repair in infants with noncyanotic CHD even when fluid restricted and apparently causes minimal respiratory complications in these infants.
authors.affiliation: Department of Anesthesia, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ze'ev
authors.initials: Z
authors.lastname: Shenkman
authors.forename: Victor M
authors.initials: VM
authors.lastname: Johnson
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Shmuel
authors.initials: S
authors.lastname: Arnon
authors.forename: Navil F
authors.initials: NF
authors.lastname: Sethna
mesh_terms: D000775:Anesthesia, Spinal; D000779:Anesthetics, Local; D062186:Arterial Pressure / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006552:Hernia, Inguinal / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D016343:Monitoring, Intraoperative; D010092:Oximetry; D010108:Oxyhemoglobins / Q000378:metabolism; D012189:Retrospective Studies; D013748:Tetracaine; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D010108:Oxyhemoglobins; D013748:Tetracaine; D002045:Bupivacaine