Abstract
With advances in neonatology, there is an increasing need for central vascular access in extremely small (<1,000 g) premature infants. Although the use of peripherally inserted central venous lines have become common practice, surgeons still frequently perform central venous line placements via cut-down in difficult access patients. The advantages of general anesthesia for vascular access procedures are obvious for optimal pain control and ideal operative exposure; however, extremely premature infants are at significant risk for prolonged endotracheal intubation with postoperative apneas. We report two cases where regional caudal anesthesia with bupivacaine and clonidine without intubation was successfully utilized at bedside during central venous line placements in premature infants weighing <600 g. The operative field was ideal with adequate motor and sensory block with caudal anesthesia and both infants received only oxygen by nasal cannula.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Frumiento C, Abajian JC, Vane DW (2000) Spinal anesthesia for preterm infants undergoing inguinal hernia repair. Arch Surg 135:445–451
Shenkman Z, Hoppenstein D, Litmanowitz I et al (2002) Spinal anesthesia in 62 premature, former-premature or young infants–technical aspects and pitfalls. Can J Anaesth 49:262–269
Vila R, Lloret J, Munar F et al (2002) Spinal anaesthesia for inguinal herniotomy in preterm infants sedated with nitrous oxide: a comparison of lumbar puncture in the lateral or sitting position. Anaesthesia 57:1164–1167
Tobias JH, Chambers TJ, Gallagher A (1994) The effects of ovarian transplantation on bone loss in ovariectomized rats. J Endocrinol 142:187–192
Bouchut JC, Dubois R, Foussat C et al (2001) Evaluation of caudal anaesthesia performed in conscious ex-premature infants for inguinal herniotomies. Paediatr Anaesth 11:55–58
Johr M, Seiler SJ, Berger TM (2000) Caudal anesthesia with ropivacaine in an awake 1,090-g baby. Anesthesiology 93:593
Jobe AH (1993) Pulmonary surfactant therapy. N Engl J Med 328:861–868
Krane EJ, Haberkern CM, Jacobson LE (1995) Postoperative apnea, bradycardia, and oxygen desaturation in formerly premature infants: prospective comparison of spinal and general anesthesia. Anesth Analg 80:7–13
Somri M, Gaitini L, Vaida S et al (1998) Postoperative outcome in high-risk infants undergoing herniorrhaphy: comparison between spinal and general anaesthesia. Anaesthesia 53:762–766
William JM, Stoddart PA, Williams SA et al (2001) Post-operative recovery after inguinal herniotomy in ex-premature infants: comparison between sevoflurane and spinal anaesthesia. Br J Anaesth 86:366–371
Cote CJ, Zaslavsky A, Downes JJ et al (1995) Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis. Anesthesiology 82:809–822
Gunter JB, Watcha MF, Forestner JE et al (1991) Caudal epidural anesthesia in conscious premature and high-risk infants. J Pediatr Surg 26:9–14
Cucchiaro G, De Lagausie P, El-Ghonemi A et al (2001) Single-dose caudal anesthesia for major intraabdominal operations in high-risk infants. Anesth Analg 92:1439–1441
Constant I, Gall O, Gouyet L et al (1998) Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children. Br J Anaesth 80:294–298
Takasaki M (1984) Blood concentrations of lidocaine, mepivacaine and bupivacaine during caudal analgesia in children. Acta Anaesthesiol Scand 28:211–214
Acknowledgements
We thank Jordan Kicklighter and Christy Perry from the Editorial Office in the Department of Anesthesiology and Eileen Figueroa and Karen Martin from the Department of Surgery for their assistance in preparing and editing this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Abouleish, A.E., Chung, D.H. & Cohen, M. Caudal anesthesia for vascular access procedures in two extremely small premature neonates. Ped Surgery Int 21, 749–751 (2005). https://doi.org/10.1007/s00383-005-1474-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-005-1474-x