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

Abstract

Background: The use of spinal anesthesia in infants is seeing resurgence as an alternative to general anesthesia. Aims: Our primary aims are to describe our institution's experience introducing a spinal anesthesia and sedation protocol for infants undergoing urologic surgery, to describe methods of improving prolonged anesthesia, and to describe the failure rate of spinal anesthesia in these patients. Sedation was provided for some infants with intranasal dexmedetomidine ± fentanyl. Methods: This is a retrospective case series examining infants aged 1-<14 months who received spinal anesthesia for circumcision, orchiopexy, orchiectomy, hypospadias repair, or epispadias repair. The electronic medical record was reviewed and compared with unmatched historical controls who received general anesthesia. Results: A total of 230 patients underwent a urologic procedure; 102 patients received spinal anesthesia and 128 received general anesthesia. Length of surgical time with spinal anesthesia ranged from 4 to 189 minutes. The hospital length of stay was shorter in the spinal anesthesia group (median [IQR] of 5.3 hours [4.3, 7.2]) compared to the general anesthesia group (17.1 hours [15.6, 17.5]).The median bupivacaine dose was 0.75 mg/kg [0.67, 0.85]. There was one case in which cerebral spinal fluid was unable to be obtained, and one case that required conversion to general anesthesia after surgery had started. There were no cases of apnea, bleeding, infection, or neurologic compromise. Conclusions: We describe the successful implementation of an infant spinal anesthesia and sedation protocol and a technique that uniquely provides prolonged surgical anesthesia with a low failure rate. We also report shorter anesthesia time, surgical time, and recovery room length of stay in patients who received spinal anesthesia compared to general anesthesia.

Efficacy and Safety of Dexmedetomidine Combined with Bupivacaine in Infants’ Surgeries: A Randomized Controlled Trial

“…To our surprise, the time to discharge from PACU was not statistically significantly different between the studied groups. Handlogten et al results had a different opinion where SA using dexmedetomidine had a role in decreasing the time to discharge from PACU to a median of 49 minutes, which is shorter in comparison to the patients who received other drugs or had GA (17) . medetomidine was added to bupivacaine which augmented its efficacy.…”