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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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Spinal anesthesia Children Clonidine Epinephrine 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Tzong KY, Han S, Roh A, Ing C. Epidemiology of pediatric surgical admissions in US children: data from the HCUP kids inpatient database. J Neurosurg Anesthesiol. 2012;24:391–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Wang X, Xu Z, Miao CH. Current clinical evidence on the effect of general anesthesia on neurodevelopment in children: an updated systematic review with meta-regression. PLoS One. 2014;9:e85760.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
  4. 4.
    Williams RK, Adams DC, Aladjem EV, Kreutz JM, Sartorelli KH, Vane DW, Abajian JC. The safety and efficacy of spinal anesthesia for surgery in infants: the Vermont Infant Spinal Registry. Anesth Analg. 2006;102:67–71.CrossRefPubMedGoogle Scholar
  5. 5.
    Lambertz A, Schälte G, Winter J, Röth A, Busch D, Ulmer TF, Steinau G, Neumann UP, Klink CD. Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases. Pediatr Surg Int. 2014;30:1069–73.CrossRefPubMedGoogle Scholar
  6. 6.
    Kokki H. Spinal blocks. Paediatr Anaesth. 2012;22:56–64.CrossRefPubMedGoogle Scholar
  7. 7.
    Rochette A, Raux O, Troncin R, Dadure C, Verdier R, Capdevila X. Clonidine prolongs spinal anesthesia in newborns: a prospective dose-ranging study. Anesth Analg. 2004;98:56–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Abajian JC, Mellish RW, Browne AF, Perkins FM, Lambert DH, Mazuzan JE Jr. Spinal anesthesia for surgery in the high-risk infant. Anesth Analg. 1984;63:359–62.CrossRefPubMedGoogle Scholar
  9. 9.
    Batra YK, Lokesh VC, Panda NB, Rajeev S, Rao KL. Dose-response study of intrathecal fentanyl added to bupivacaine in infants undergoing lower abdominal and urologic surgery. Pediatr Anesth. 2008;18:613–9.CrossRefGoogle Scholar
  10. 10.
    Whitaker EE, Wiemann BZ, DaJusta DG, Alpert SA, Ching CB, McLeod DJ, Tobias JD, Jayanthi VR. Spinal anesthesia for pediatric urological surgery: reducing the theoretic neurotoxic effects of general anesthesia. J Pediatr Urol. 2017;13:396–400.CrossRefPubMedGoogle Scholar
  11. 11.
    Frawley G, Bell G, Disma N, Withington DE, de Graaff JC, Morton NS, McCann ME, Arnup SJ, Bagshaw O, Wolfler A, Bellinger D, Davidson AJ. General anesthesia compared to spinal anesthesia (GAS) consortium. Predictors of failure of awake regional anesthesia for neonatal hernia repair: data from the general anesthesia compared to spinal anesthesia study—comparing apnea and neurodevelopmental outcomes. Anesthesiology. 2015;123:55–65.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Rochette A, Troncin R, Raux O, Dadure C, Lubrano JF, Barbotte E, Capdevila X. Clonidine added to bupivacaine in neonatal spinal anesthesia: a prospective comparison in 124 preterm and term infants. Paediatr Anaesth. 2005;15:1072–7.PubMedGoogle Scholar
  13. 13.
    Kachko L, Birk E, Simhi E, Tzeitlin E, Freud E, Katz J. Spinal anesthesia for noncardiac surgery in infants with congenital heart diseases. Paediatr Anaesth. 2012;22:647–53.CrossRefPubMedGoogle Scholar
  14. 14.
    Kachko L, Simhi E, Tzeitlin E, Efrat R, Tarabikin E, Peled E, Metzner I, Katz J. Spinal anesthesia in neonates and infants—a single-center experience of 505 cases. Paediatr Anaesth. 2007;17:647–53.CrossRefPubMedGoogle Scholar
  15. 15.
    Ing C, Sun LS, Friend AF, Roh A, Lei S, Andrews H, Li G, Williams RK. Adverse events and resource utilization after spinal and general anesthesia in infants undergoing pyloromyotomy. Reg Anesth Pain Med. 2016;41:532–7.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kachko L, Simhi E, Freud E, Dlugy E, Katz J. Impact of spinal anesthesia for open pyloromyotomy on operating room time. J Pediatr Surg. 2009;44:1942–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Batra YK, Rakesh SV, Panda NB, Lokesh VC, Subramanyam R. Intrathecal clonidine decreases propofol sedation requirements during spinal anesthesia in infants. Paediatr Anaesth. 2010;20:625–32.CrossRefPubMedGoogle Scholar
  18. 18.
    López T, Sánchez FJ, Garzón JC, Muriel C. Spinal anesthesia in pediatric patients. Min Anestesiol. 2012;78:78–87.Google Scholar
  19. 19.
    Ratajczak-Enselme M, Estebe JP, Rose FX, Wodey E, Malinovsky JM, Chevanne F, Dollo G, Ecoffey C, Le Corre P. Effect of epinephrine on epidural, intrathecal, and plasma pharmacokinetics of ropivacaine and bupivacaine in sheep. Br J Anaesth. 2007;99:881–90.CrossRefPubMedGoogle Scholar
  20. 20.
    Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984–1995). Anesthesiology. 1996;85:655–74.CrossRefPubMedGoogle Scholar
  21. 21.
    Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology. 2003;98:428–36.CrossRefPubMedGoogle Scholar

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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