title: Spinal anesthesia in infants and children: A one year prospective audit.
abstract: OBJECTIVE
  Spinal anesthesia though gaining popularity in children, the misconceptions regarding its safety and feasibility can be better known with greater use and experience. The objective of this study was to evaluate the success rate, complications and hemodynamic stability related to pediatric spinal anesthesia.
  
  
  METHODS
  In this 1-year prospective study, 102 pediatric patients aged 6 months to 14 years undergoing infraumbilical and lower extremity surgery were included. Spinal anesthesia was administered using hyperbaric bupivacaine 0.5% in a dose of 0.5 mg/kg (for child < 5 kg), 0.4 mg/kg (for 5-15 kg), 0.3 mg/kg (for >15 kg) in L4-L5 space under all aseptic precautions after sedation. Demographic data, vital parameters, supplemental sedation, number of attempts for lumbar puncture, sensory-motor block characteristics, and complications were noted.
  
  
  RESULTS
  Spinal anesthesia was successful in 98 (97.1%) patients. Remaining 4 (3.9%) were failures and were given general anesthesia. Lumbar puncture was successful in first attempt (60 [58.82%]) or 2(nd) attempt (42 [41.18%]). There was no significant change in vital parameters. Mean peak sensory level was T 6.35 ± 1.20 (T4-T8). Mean sensory level at the end of surgery was T 8.11 ± 1.42 (T6-T10). Modified Bromage score was 3 in 98 (96.08%) patients. Sensory and motor block recovery was complete in all patients. Mean time to two segment regression was 43.97 ± 10.72 (30-70) min. Mean time to return Bromage score to 0 was 111.95 ± 20.54 (70-160). Mean duration of surgery was 52.5 ± 16.056 (25-95) min. Incidence of complications was minimal with hypotension occurring in 2 (2%) and shivering in 3 (2.9%) patients.
  
  
  CONCLUSIONS
  Pediatric spinal anesthesia is a safe and effective anesthetic technique for lower abdominal and lower limb surgeries of shorter duration (<90 min) with high success rate. Owing to, its early motor recovery, it can be a preferred technique for day case surgeries in the pediatric population.
authors.affiliation: Department of Anaesthesiology and Critical Care, Rabindra Nath Tagore Medical College, Udaipur, Rajasthan, India.
authors.forename: Devendra
authors.initials: D
authors.lastname: Verma
authors.affiliation: Department of Anaesthesiology and Critical Care, Rabindra Nath Tagore Medical College, Udaipur, Rajasthan, India.
authors.forename: Udita
authors.initials: U
authors.lastname: Naithani
authors.affiliation: Department of Anaesthesiology and Critical Care, Rabindra Nath Tagore Medical College, Udaipur, Rajasthan, India.
authors.forename: Chayenika
authors.initials: C
authors.lastname: Gokula
authors.affiliation: Department of Anaesthesiology and Critical Care, Rabindra Nath Tagore Medical College, Udaipur, Rajasthan, India.
authors.lastname: Harsha
keywords: Complications; hemodynamics; infants; infraumbilical; spinal anesthesia; success rate