Spinal Anesthesia for Pediatric Laparoscopic Hernia Repair: A Case Report

Abstract

Spinal anesthesia is practical and safe in infants and toddlers and prevents perioperative complications including cardiorespiratory instability and apnea. Other perioperative advantages include reduced time from surgery completion to operating room exit and first feed. This article presents the case of an ex-premature infant who underwent laparoscopic inguinal hernia repair under spinal anesthesia. The infant remained calm and stable throughout the uneventful procedure and postoperative period. Spinal anesthesia may be feasible for laparoscopic herniotomy when pneumoperitoneum pressure and operative time are restricted to 8 mm Hg and 60 minutes, respectively, with sensory level at T10 or higher.

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

“…According to this new dosage regimen (the maximum dose was 1.25 mg/kg), an increase in both the duration (up to 100 min) and the sensory level (up to T6) was observed, which allowed to broaden the spectrum of surgical procedures (see Table 3). 11,14,[22][23][24][25][26][27][28] As regards local anesthetic adjuvants, we can use those that prolong motor block (e.g., epinephrine or neostigmine), that prolong analgesia (e.g., fentanyl or morphine), or that prolong both motor block and analgesia (e.g., clonidine or dexmedetomidine).…”

“…As the program evolved, new indications were added to this technique (see Table 3), some of them pioneering, such as laparoscopic inguinal herniotomy. 14,16,21 Concerning the type of local anesthetic, the initial idea was to have several options to choose from depending on the surgical time, taking advantage of the pharmacological properties of the different local anesthetics. Thus, the most used local anesthetic was hyperbaric 0.5% bupivacaine, given its shorter motor block duration compared to the isobaric form (this effect is less noticeable in children than in adults), and that most procedures had an estimated surgical time <60 min.…”

“…Likewise, spinal anesthesia was also used in day‐case surgery, with the exception of high‐risk patients (i.e., ex‐prematures <60 weeks of PMA or children ASA ≥3), who remained hospitalized. As the program evolved, new indications were added to this technique (see Table 3), some of them pioneering, such as laparoscopic inguinal herniotomy 14,16,21 …”

“…Local anesthetic doses were initially calculated based only on patient's weight (i.e., 0.5 mg/kg for <5 kg; 0.4 mg/kg for 5–15 kg; 0.3 mg/kg for >15 kg), although a dosing chart was subsequently developed based on patient's age and desired sensory level (see Table 1). 11–14 …”

“…Local anesthetic doses were initially calculated based only on patient's weight (i.e., 0.5 mg/kg for <5 kg; 0.4 mg/kg for 5-15 kg; 0.3 mg/kg for >15 kg), although a dosing chart was subsequently developed based on patient's age and desired sensory level (see Table 1). [11][12][13][14] Procedural sedation was used in all children to avoid psychological stress as well as movement during the LP and thus enhance safety and success of spinal block. In children <3 years old, it was only performed during the lumbar puncture, using sevoflurane (1-3%) through nasal prongs, midazolam iv (0.1-0.5 mg/kg), propofol (1-2.5 mg/kg), or dexmedetomidine (0.5-1 μg/kg), with generally no need for maintenance (given the more pronounced sensory deafferentation-dependent sedative effect in this age group).…”