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Spinal anesthesia in 62 premature, former-premature or young infants–technical aspects and pitfalls

[La rachianesthésie chez 62 enfants prématurés, anciens prématurés ou jeunes enfants - aspects techniques et pièges]

Ze'ev Shenkman, MD^*, David Hoppenstein, MB BCH DA(SA)^*, Ita Litmanowitz, MD, Shy Shorer, MD^*, Michael Gutermacher, MD, Ludvig Lazar, MD, Ilan Erez, MD, Robert Jedeikin, BSc MB CHB FFA^* and Enrique Freud, MD

^* From the Departments of Anesthesia and Critical Care Medicine,
Neonatal Intensive Care Unit, and
Pediatric Surgery, Meir Hospital, Kfar Saba, Israel, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Dr. Ze'ev Shenkman, Department of Anesthesia and Intensive Care, Meir Hospital, Tshernichovsky Street, Kfar Saba 44281, Israel. Phone: 972-9-747-1545; Fax: 972-9-742-3233; E-mail: shlomsh{at}netvision.net.il

Purpose: To highlight technical aspects and pitfalls of spinal anesthesia (SA) in infants.

Methods: The medical history and perioperative course of all infants who underwent SA over a 28-month period were collected (retrospectively in the first 20).

Results: Sixty-two infants underwent surgery under SA. Fifty-five were premature and former-premature, postconceptional age 43.3 ± 5.0 weeks, weight 3261 ± 1243 g. Of these, 21 had co-existing disease: cerebral (six), cardiac (nine), pulmonary (11) and urological (six). Hyperbaric tetracaine or bupivacaine 1 mg•kg^-1 with adrenaline was administered. Four infants (three premature) required N₂O supplementation and three needed general anesthesia. The supplementation rate was similar or lower than in previous studies. Postoperatively, all seven were shown to have lower limb motor and sensory blockade. Complications in premature patients included intraoperative hypoxemia (two), apnea (two) and bradycardia (one). Postoperative complications included bradycardia (three), hypoxemia (one) and apnea and hypoxemia (one). The postoperative complication rate was similar to previous studies.

Conclusion: Successful SA in infants depends on close attention to preoperative assessment, appropriate patient positioning during and after lumbar puncture, drug dosing and intra- and postoperative cardiorespiratory monitoring. A relatively high dose of hyperbaric solution of tetracaine or bupivacaine with adrenaline should be administered.

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