Spinal anaesthesia for inguinal hernia repair in high-risk neonates

Webster, A. C.; McKishnie, J. D.; Kenyon, Cynthia F.; Marshall, Donald G.

doi:10.1007/bf03007615

Cited by 81 publications

(53 citation statements)

References 22 publications

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“…Welborn et al [7] found that the risk of postoperative apnoea increases when intra-operative sedation is given during surgery under spinal anaesthesia in former preterm infants. The need for supplementary general anaesthesia increases the incidence of respiratory complications [3,10]. Although a recently published review article addressed the topic of spinal anaesthesia in neonates and children [11], and another article discussed the positions in which the spinal anaesthetic can be administered [8], there is little published information comparing the effects of the spinal administration of bupivacaine 0.5% in the lateral and sitting positions.…”

Section: Discussionmentioning

confidence: 99%

“…The main characteristics in infants, especially premature infants, are that the doses of local anaesthetics are three-to fivefold those used for adults on a weight-for-weight basis, have a briefer duration of action, and are well tolerated, with few adverse effects [10,13,14]. The cardiovascular stability associated with spinal and epidural anaesthesia in infants is attributed to the relative immaturity of the sympathetic nervous system, with a lesser effect on vascular tone and venous capacity.…”

Section: Discussionmentioning

confidence: 99%

“…A number of factors contribute to the unpredictable spread of local anaesthetics [6,10,13,[16][17][18]. The height of the subarachnoid block may be related to the vertebral level of injection, dose, volume and temperature of local anaesthetic, speed of administration, density and baricity of the solution, the use of borbotage, anatomical variation, position of the patient before and after lumbar puncture, and CSF volume.…”

Section: Discussionmentioning

confidence: 99%

“…Variability in CSF volume is an important factor contributing to spread of spinal anaesthesia [17]. CSF loss due to undetected multiple dural punctures [10], more frequently associated with the use of smaller diameter needles, can significantly decrease CSF volume, augment dermatomal spread and increase the duration of spinal blockade [15]. We used 2.5 cm 22 G needles because the time taken for CSF to appear at the needle hub is short, and thinner needles make the procedure difficult without providing any proven benefit to children [19].…”

Section: Discussionmentioning

confidence: 99%

“…Lower doses may provide inadequate anaesthesia [6]. Clinical experience has shown that premature and ex-premature infants require more local anaesthetic to achieve the same level of analgesia than infants born at term [6,10]. The use of isobaric bupivacaine may be safer in these patients because changes in position should not affect its spread.…”

Section: Discussionmentioning

confidence: 99%

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Spinal anaesthesia for inguinal herniotomy in preterm infants sedated with nitrous oxide: a comparison of lumbar puncture in the lateral or sitting position

Vilà

Lloret²,

Munar

et al. 2002

Anaesthesia

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SummaryThis study compares spinal anaesthesia for inguinal herniotomy in preterm infants in the lateral or sitting position. Thirty patients were randomly divided into two equal groups. One hour before spinal anaesthesia, a eutetic mixture of local anaesthetic cream was applied to the lower lumbar spine. Sedation with nitrous oxide 50% in oxygen was given to all patients before and during induction of spinal anaesthesia, and throughout surgery. Lumbar punctures were performed at the L 4)5 interspace using a 2.5 cm 22 G needle. Isobaric bupivacaine 0.5% with epinephrine 1 : 200 000 at a bupivacaine dose of 1 mg.kg )1 was injected in the lateral or sitting position. Measurements included heart rate, blood pressure, oxygen saturation, maximum sensory block height and duration of motor block and analgesia. There were no statistically significant differences between the groups in any measured parameters. Median Our results indicate that in preterm infants sedated with nitrous oxide, spinal anaesthesia for inguinal herniotomy performed with isobaric bupivacaine 0.5% at a dose 1.0 mg.kg )1 in the lateral or sitting position is equally effective and is associated with minimal side effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Spinal anaesthesia for inguinal herniotomy in preterm infants sedated with nitrous oxide: a comparison of lumbar puncture in the lateral or sitting position

Vilà

Lloret²,

Munar

et al. 2002

Anaesthesia

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Spinal Anesthesia for Preterm Infants Undergoing Inguinal Hernia Repair

Frumiento

Abajian²,

Vane³

2000

Arch Surg

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Regional anaesthesia in high-risk infants

1992

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We were impressed with the number of problems reported by Webster et al., in their experience providing spinal anaesthesia for high-risk neonates, l Also we have encountered some complications and reviewed our experience over a four-year period.We attempted to perform spinal anaesthesia for inguinal hernia repair in 62 expremature infants with a mean weight of 2.9 kg and a mean postconceptual age of 42 wk. Tetracaine with epinephrine was used for all patients, usually in a dose of 0.4 mg. kg -1 and a minimum of 1 mg. Placement of the block was done in the lateral decubitus position.We were unable to locate CSF in six patients. In four infants the sensory level achieved was inadequate to perform the procedure, and general anaesthesia was required. In two infants, the sensory level was sufficient to repair the symptomatic hernia, but it receded too quickly to allow exploration of the asymptomatic side. Two infants developed respiratory insufficiency associated with high segmental blocks and required tracheal intubation. Two infants developed hypotension shortly after the block was placed which responded to fluid boluses. One infant with no preoperative history of apnoea and who received no sedation had apnoeic episodes intraoperatively. Twenty of the infants required some sedation intraoperatively, usually ketamine, but rarely morphine, fentanyl, thiopentone or nitrous oxide. There were no intraoperative respiratory complications in those patients who received sedatives.Postoperatively, five of the infants had apnoeic episodes within the first 24 hr of surgery. One episode was temporally related to the use of morphine for postoperative analgesia. The other four infants had preoperative histories of apnoea, and had received no sedatives in the perioperative period.While we believe that regional anaesthesia in this highrisk population is preferable to general anesthesia, we have found that spinal anaesthesia is not without complications. Since reviewing these 62 cases, we discovered that increasing the dosage of tetracaine has provided higher sensory levels and a longer duration of block. The technical problems of the difficult or failed spinal are not so easily rectified. We have found that placing caudals is usually easier and associated with a high success rate. z3 The onset of sensory blockade is slower, and muscle relaxation is not as profound with caudal anaesthesia as with spinal anaesthesia. Despite this, our surgeons have been pleased with the uniformly successful blocks. We now routinely initially attempt caudal blockade using 0.375% bupivicaine with 1:200,000 epinephrine unless there is a contraindication. Extradural blood patch for post-lumbar puncture headaches in cancer patientsTo the Editor: We were recently asked to evaluate a 19-yr-old girl who was severely debilitated by a headache 24 hr after diagnostic lumbar puncture. The patient with a diagnosis of embryonal cell rhabdomyosarcoma required a lumbar puncture in accordance with her assigned treatment protocol to survey for evidence of central ner...

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Spinal anaesthesia for inguinal hernia repair in high-risk neonates

Cited by 81 publications

References 22 publications

Spinal anaesthesia for inguinal herniotomy in preterm infants sedated with nitrous oxide: a comparison of lumbar puncture in the lateral or sitting position

Spinal anaesthesia for inguinal herniotomy in preterm infants sedated with nitrous oxide: a comparison of lumbar puncture in the lateral or sitting position

Spinal Anesthesia for Preterm Infants Undergoing Inguinal Hernia Repair

Regional anaesthesia in high-risk infants

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