Implementation of a spinal anesthesia and sedation protocol that reliably prolongs infant spinal anesthesia: Case series of 102 infants who received spinal anesthesia for urologic surgery.
Aim and method
A retrospective case study on infants aged 1 to 14 months having urologic surgery on external male genitalia describing this institution’s spinal anaesthesia and sedation protocol and comparing this with their own unmatched historical controls receiving general anaesthesia.
102 patients received spinal anaesthesia for urologic surgery and were compared to 128 who received general anaesthesia. 2 cases required conversion to general anaesthesia (failure to obtain CSF and excessive movement intraoperatively). No cases of apnoea, bleeding, infection or neurologic compromise.
The use of preoperative intranasal dexmedetomidine, intranasal fentanyl and topical lidocaine provided safe and excellent conditions for intrathecal puncture and subsequent lower limb intravenous cannula placement. There was a low failure rate, longer than previously described spinal anaesthesia times (up to 3 hours) and no significant adverse effects. The technique was adjusted during the study to give IV atropine once the IVC was placed after frequent bradycardia was noted in previous cases.
As noted by the authors, perhaps the most significant limitation of this data is the retrospective and descriptive nature of the study design. Historical patients who received GA were not matched, limiting the value of the results and the ability to objectively compare the two groups. Because of these factors, no formal conclusions can be drawn regarding outcomes compared to GA.
Reviewed by Dr David Vyse