title: Spinal anesthesia plus ketamine-midazolam sedation for pediatric orthopedic surgery in a developing country.
abstract: BACKGROUND
  Spinal anesthesia produces a profound and uniformly distributed sensory block with rapid onset and muscle relaxation, and results in complete control of cardiovascular and stress responses. Ketamine is an anesthetic agent that is widely used for pediatric sedations in settings where safety and efficacy of the agents are mandatory because of limited healthcare resources. The authors report on their experience in a refugee hospital located in Bol-la (Saharawi, Algeria).
  
  
  METHODS
  Spinal anesthesia was performed for orthopedic surgery procedures in children. Before the spinal puncture, the patients were sedated with intramuscular ketamine followed by intravenous ketamine and midazolam. Boluses of midazolam were also administered throughout the surgery to keep the patients sedated; spinal anesthesia was performed with levobupivacaine 0.25 mg/kg.
  
  
  RESULTS
  There were no intraoperative adverse events; vital signs were within the normal pediatric ranges during the procedures and there was no need to switch to general anesthesia. In the postoperative period, no symptoms of dural puncture headache or postoperative delirium or nightmares were reported.
  
  
  CONCLUSIONS
  Based on the authors' experience, the combination of spinal anesthesia and sedation with midazolam and ketamine was found to be a safe approach for children undergoing orthopedic surgery in a low resources setting.
authors: Anaesthesia and Intensive Care Unit, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy.
authors: E
authors: E
authors: Piraccini
authors: R
authors: R
authors: Albarello
authors: C
authors: C
authors: Biagini
authors: A
authors: A
authors: Novi
authors: V
authors: V
authors: Agnoletti
authors: G
authors: G
authors: Gambale
keywords: developing world; ketamine; pediatric anesthesia; pediatric sedation; spinal anesthesia