Journal of Anesthesia

, Volume 32, Issue 4, pp 637–640 | Cite as

Spinal anesthesia for surgery longer than 60 min in infants: experience from the first 2 years of a spinal anesthesia program

  • Mehdi TrifaEmail author
  • Dmitry Tumin
  • Emmett E. Whitaker
  • Tarun Bhalla
  • Venkata R. Jayanthi
  • Joseph D. Tobias
Clinical Report



Spinal anesthesia (SA) is being increasingly used in infants to avoid the potential negative neurocognitive effects of general anesthesia (GA). However, SA has been reported to provide a relatively short duration of surgical anesthesia.


We retrospectively reviewed SA cases for surgical procedures lasting more than 60 min in children up to 3 years old. All patients received bupivacaine 0.5% (1 mg/kg up to 7 mg) with clonidine 1 µg/kg ± epinephrine. The primary outcome was success of SA without subsequent conversion to GA.


Thirty-five patients met inclusion criteria (all males, age 7 ± 5 months, weight 8 ± 2 kg). Procedures included male genital, groin and multiple site surgeries. Average surgical duration was 71 ± 12 min (range 60–111 min). SA was successful in 31 of 35 patients (89%; 95% confidence interval 78, 99%). The cause of failure was rarely due to the duration of surgery (1 of 4 patients). Six patients with successful SA required sedation with dexmedetomidine ± fentanyl. Differences in procedure duration and patient characteristics were not statistically significant between successful and failed SA.


SA is a highly successful technique and may offer an alternative to GA in children undergoing appropriate surgery expected to last as long as 60–100 min.


Spinal anesthesia Children Clonidine Epinephrine 




Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology, Pain MedicineNationwide Children’s HospitalColumbusUSA
  2. 2.Faculty of MedicineUniversity of Tunis El ManarTunisTunisia
  3. 3.Department of Anesthesiology, Pain MedicineThe Ohio State University College of MedicineColumbusUSA
  4. 4.Division of Pediatric UrologyNationwide Children’s HospitalColumbusUSA
  5. 5.Department of UrologyThe Ohio State University College of MedicineColumbusUSA

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