Avoidance of deep anesthesia and artificial airways in 1000 neonates and infants using regional anesthesia: A retrospective observational analysis

Abstract

Background and Aims: Current concerns related to the anesthetic neurotoxicity have brought a renewed interest in regional anesthesia. Regional anesthesia reduces the need for opioids and inhalational anesthetics. The immaturity of the neonatal and infant nervous system may render them more prone to neurotoxicity. We describe our technique of anesthesia, which minimizes the exposure to general anesthetics and reduces airway instrumentation because the operability is rendered by the regional block. Material and Methods: This was a retrospective case series of neonates and infants undergoing common surface surgeries. We describe our technique of anesthesia where regional blocks are the mainstay. We also put up the data pertaining to block effectiveness, technique, end-tidal sevoflurane concentration and complications. Results: One thousand patients, including neonates and infants, received central and peripheral nerve blockade. The failure rate in upper extremity blocks 0% without complications. 86.12% were given under ultrasonography (USG) guidance and 13.89% were given with peripheral nerve stimulation. The failure rate of sciatic block single shot and continuous was 0%. 92.53% were given with USG guidance while 7.46% received sciatic with nerve stimulation technique. Failure rate of caudal epidural block was 0. 78% requiring a rescue analgesic, 1.4% had blood in the needle. Out of the caudals, 33.33% were done with USG guidance and 66.67% blocks were given with traditional techniques. Out of the 322 penile + ring blocks given by traditional method, 1 block failed requiring rescue analgesics. The mean sevoflurane concentration was 1.2 +/- 0.32. Conclusion: It is feasible to conduct surface surgeries in the most vulnerable population such as neonates and infants under regional anesthesia without intubation and airway instrumentation.

Practicing pediatric regional anesthesia: Children are not small adults

“…[ 3 ] The article by Ponde et al . [ 5 ] reflects this thought process. In this randomized, prospective pilot study, they have compared the efficacy of standard target site (posterior cord) for infraclavicular block with alternate target site (lateral cord) in 40 children.…”

Interscalene brachial plexus block in a neonate: Here's how

“…Standard monitors were attached, and ultrasound-guided ISB was planned under sevoflurane, oxygen and air with face mask with spontaneous ventilation via a Jackson Rees circuit. [ 2 ] The vital parameters were normal. The head was secured on a well-fitting headrest and was slightly turned to the right side.…”