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Review of Spinal Anesthesia for Pediatric Genitourinary Surgery

  • Pediatric Urology (BA VanderBrink and RP Pramod, Section Editors)
  • Published:
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Abstract

Purpose of Review

In this review, we aim to provide insight into the current state of spinal anesthesia (SA) in pediatric urologic surgery while also acknowledging its historical use in pediatric general and orthopedic procedures. More specifically, we will highlight our own institutional protocol and techniques aimed at prolonging the effects of spinal anesthesia for cases with an anticipated duration lasting > 60 min.

Recent Findings

Recent studies have described success rates of nearly 90% for a wide range of operative times, with the maximum duration reported to be nearly 3 h. Most studies include a variety of penoscrotal cases under a single-shot spinal block of bupivacaine with or without adjunct medications, preoperatively and intraoperatively, to prolong effects. However, an approach has been described for more complex cases including ureteral reimplantation, ureterocele repair, megaureter repair, open pyeloplasty, and feminizing genitoplasty, combining spinal injection and caudal catheter placement.

Summary

Spinal anesthesia for pediatric urologic surgery requires close collaboration between anesthesiology and surgical teams. In general, spinal anesthesia has been used to safely perform urologic cases lasting < 60 min in duration; however, adjunctive medications have been used to prolong effects for longer, more complex cases with excellent outcomes.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author, [CFG].

Abbreviations

SA:

Spinal anesthesia

PUV:

Posterior urethral valve

PACU:

Post-anesthesia care unit

LOS:

Length of stay

OR:

Operating room

References and Recommended Reading

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Author notes

  1. Bridget L. Findlay and Francis A. Jefferson have equal contribution.

Authors and Affiliations

  1. Department of Urology, Mayo Clinic, 200 1St St SW, Rochester, MN, 55905, USA

    Bridget L. Findlay MD, Francis A. Jefferson MD, Patricio C. Gargollo MD & Candace F. Granberg MD

  2. Department of Anesthesiology, Mayo Clinic, 200 1St St SW, Rochester, MN, 55905, USA

    Dawit Haile MD

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  1. Bridget L. Findlay MD
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  5. Candace F. Granberg MD
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Corresponding author

Correspondence to Candace F. Granberg MD.

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Bridget L. Findlay declares that she has no conflict of interest. Francis A. Jefferson declares that he has no conflict of interest. Patricio C. Gargollo declares that he has no conflict of interest. Dawit Haile declares that he has no conflict of interest. Candace F. Granberg declares that she has no conflict of interest.

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Findlay, B.L., Jefferson, F.A., Gargollo, P.C. et al. Review of Spinal Anesthesia for Pediatric Genitourinary Surgery. Curr Treat Options Peds 9, 81–92 (2023). https://doi.org/10.1007/s40746-023-00269-y

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