Pediatric spinal anesthesia at a tertiary care hospital: Eleven years after

Abstract

Anesthesia-related critical incidents in pediatric patients occurred three times more frequently than in adults and, moreover, three times higher in infants (<1 year of age) than in children (>1 year of age). The overall incidence of critical events requiring intervention is 35%, most of them related to hypotension and hypoxemia episodes, occurring during the maintenance of anesthesia. The major risk factors in children undergoing anesthesia are age (<1 year), prematurity (<37 weeks of gestation), and comorbidity (American Society of Anesthesiologists [ASA] physical status ≥3). [1][2][3] Pediatric spinal anesthesia was initially described by August Bier in 1898, and its use was rather common before the advent of halogenated agents that made anesthesia safer. However, spinal block did not become popular again until 1980s, when Abajian first described the high-risk infant (subsequently defined as the ex-premature infant whose postmenstrual age [PMA] at surgery is <60 weeks) as a target patient for this technique, and over the last few years, due to the growing concern about the potential general anesthetic-induced neurotoxicity in young children. [4][5][6][7][8] While its current use is not so widespread, this technique has various advantages compared to general anesthesia, by reducing the risk of cardiorespiratory events (hypoxemia, bradycardia, and hypotension) associated with general anesthesia, especially in neonates and infants. The main limitation is the duration of the anesthetic block, which reduces the number of surgical procedures to be undertaken under this technique to those lasting less than 90 min. [9][10][11] The objective of this study was to review the pediatric spinal anesthesia program at our tertiary care center-Puerta del Mar

An evaluation of spinal anesthesia results in pediatric patients undergoing pilonidal sinus surgery: a retrospective study

“…While pediatric SpA may entail complications such as hypotension, vomiting, bradycardia, desaturation, PDPH, or postoperative apnea, the rates are low. Desaturation, one of the most important complications, was reported at a rate of 2% by Eizaga Rebollar et al 3 Caliskan et al 12 reported a complication rate of 3.4%, PDPH being the major complication. Kantekin et al 13 reported a rate of 4.8%, the most important complication being foot drop.…”

“…These include less intraoperative desaturation and bradycardia, higher minimum systolic blood pressure with fewer intervention requirements, less heat loss, a lower incidence of postoperative early apnea, shorter anesthesia times from the conclusion of surgery to leaving the operating room, and shorter times to first feed. 3,11 An examination of the literature shows that pediatric SpA enjoys a high success rate. Studies with a similar design to the present research have reported success rates of 97.5-100%.…”

“…The advantages of SpA in pediatric patients include a rapid onset, the provision of adequate motor and sensory block, and reducing pain and the stress response to surgery. 2, 3 However, both anesthesiologists and surgeons have traditionally been reluctant to apply SpA in the pediatric population. 4 A survey study revealed that the unwillingness to apply SpA for routine pediatric surgical procedures is multifactorial in nature.…”

“…Other limitations include its limited effect duration (90 min) and the potential need for additional anesthetics. 3,6,7 The aim of this retrospective study is to share our experiences with SpA in children undergoing pilonidal sinus surgery and to evaluate the side-effects and complications associated with the procedure. This paper also discusses our hypothesis was concerning whether or not SpA is safe and effective in pediatric patients.…”

Paediatric pain management: from regional to virtual

“…Spinal anaesthesia for infants and children serves to avoid exposure to general anaesthesia for certain surgical procedures and can be a good option for patients with significant comorbidities such as airway anomalies, cardiopulmonary disease or sequelae of prematurity [17,18 ▪▪ ]. In infants, spinal anaesthesia confers more haemodynamic stability when compared with general anaesthesia [19], obviates the need for airway instrumentation and likely improves incidence of postoperative apnoea [20] in vulnerable populations such as premature and ex-premature patients.…”