A pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair in infants

Abstract

Dexmedetomidine sedation with caudal anesthesia is a feasible alternative to spinal or general anesthesia in selected infants undergoing uncomplicated hernia surgery. It avoids the need for endotracheal intubation and may be potentially beneficial in avoiding the unknown effects of general anesthesia on neurodevelopment.

Effects of adding dexmedetomidine to local infiltration of bupivacaine on postoperative pain in pediatric herniorrhaphy: a randomized clinical trial

“…Recently, researchers reported the extended duration of postoperative pain relief and reduced response to hernial sac traction using 1 µg/kg DEX combined with bupivacaine in children undergoing hernia repair [17,18]. Higher doses of DEX has also been proposed as a feasible anesthetic in pediatric inguinal hernia repair [19]. Furthermore, premedication with sublingual DEX has been established to be more effective than sublingual midazolam in children < 12 years of age undergoing inguinal hernia repair [20].…”

Intravenous dexmedetomidine as an ‘adjuvant’ to the infant spinal anesthetic

“…Neuraxial anesthesia combined with intravenous dexmedetomidine represents an attractive alternative to general anesthesia for avoiding potential anesthesia‐induced neurotoxicity and avoiding endotracheal intubation. As the authors noted, caudal anesthesia does not typically provide a profound enough motor block for the duration of the surgery . We share two cases that demonstrate the utility of spinal anesthesia combined with dexmedetomidine sedation.…”

“…Sir —We read with interest the pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair . Neuraxial anesthesia combined with intravenous dexmedetomidine represents an attractive alternative to general anesthesia for avoiding potential anesthesia‐induced neurotoxicity and avoiding endotracheal intubation.…”

Theseus, the Labyrinth, and the Minotaur of anaesthetic-induced developmental neurotoxicity

“…For example, rodent brain development is substantially shorter than human brain development (weeks as opposed to years). 25 The majority of rodent models used exposures considered to be lengthy (4-6 h). 1-4 6-8 11 Most importantly, the…”

“…[22][23][24] But as an adjunct to caudal anesthesia (without general anaesthesia) for infant inguinal hernia repair receiving dexmedetomidine loading dose of 3 lg kg À1 over 30 min, no significant bradycardia or hypotension was observed. 25 While use of dexmedetomidine as part of a general anaesthetic regimen in the very young is being tested for both its anaesthetic sparing and neuroprotective effects (in the TREX trial), 16 further preclinical study is required. Beyond addressing concerns related to the lack of physiological control in these studies, noxious stimuli 26 and simulated hernia surgery 9 exacerbate anaesthetic injury, perhaps through inflammatory pathways.…”