Sedation during spinal anaesthesia in infants

Hermanns, Henning; Stevens, Markus F.; Werdehausen, Robert; Braun, Sebastian; Lipfert, P.; Jetzek-Zader, M.

doi:10.1093/bja/ael156

Cited by 55 publications

(51 citation statements)

References 31 publications

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“…The BIS falls with caudal block during general anaesthesia (in older children, but not in infants) [24,25] and falls during spinal anaesthesia in infants [26].…”

Section: Bispectral Indexmentioning

confidence: 99%

Monitoring the anaesthetic depth in children – an update

Davidson

2007

Current Opinion in Anaesthesiology

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“…The BIS falls with caudal block during general anaesthesia (in older children, but not in infants) [24,25] and falls during spinal anaesthesia in infants [26].…”

Section: Bispectral Indexmentioning

confidence: 99%

Monitoring the anaesthetic depth in children – an update

Davidson

2007

Current Opinion in Anaesthesiology

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“…[1059] Limited thoracic kyphosis facilitates cephalad spread resulting in apnea, requiring assisted ventilation. [19]…”

Section: Introductionmentioning

confidence: 99%

Spinal anesthesia in children: A review

Gupta

Saha

2014

J Anaesthesiol Clin Pharmacol

121

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Even after a vast safety record, the role of spinal anesthesia (SA) as a primary anesthetic technique in children remains contentious and is mainly limited to specialized pediatric centers. It is usually practiced on moribund former preterm infants (<60 weeks post-conception) to reduce the incidence of post-operative apnea when compared to general anesthesia (GA). However, there is ample literature to suggest its safety and efficacy for suitable procedures in older children as well. SA in children has many advantages as in adults with an added advantage of minimal cardio-respiratory disturbance. Recently, several reports from animal studies have raised serious concerns regarding the harmful effects of GA on young developing brain. This may further increase the utility of SA in children as it provides all components of balanced anesthesia technique. Also, SA can be an economical option for countries with finite resources. Limited duration of surgical anesthesia in children is one of the major deterrents for its widespread use in them. To overcome this, several additives like epinephrine, clonidine, fentanyl, morphine, neostigmine etc. have been used and found to be effective even in neonates. But, the developing spinal cord may also be vulnerable to drug-related toxicity, though this has not been systematically evaluated in children. So, adjuvants and drugs with widest therapeutic index should be preferred in children. Despite its widespread use, incidence of side-effects is low and permanent neurological sequalae have not been reported with SA. Literature yields encouraging results regarding its safety and efficacy. Technical skills and constant vigilance of experienced anesthesia providers is indispensable to achieve good results with this technique.

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“…13 Warming of the feet was certainly not caused by accommodation of the infants to the environment, because temperature remained stable before the spinal anesthesia (Fig 2). Furthermore, one may argue that the effect was caused by the sedation induced by spinal anesthesia as recently described, 15 but this cause is unlikely because the skin-temperature increase of the feet was prominent within 10 minutes, whereas a significant sedation occurred later.…”

Section: Discussionmentioning

confidence: 88%