Infant spinal anesthesia: Do girls need a larger dose of local anesthetic?

Frawley, Geoff; Huque, Hamidul

doi:10.1111/pan.13219

Cited by 3 publications

(1 citation statement)

References 48 publications

(98 reference statements)

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“…The 0.375% concentration in our series, with comparable total amounts of ropivacaine administered to both sexes, appears to support this notion that a minority of girls would benefit from even higher concentrations. Furthermore, a report on spinal anesthesia in infants, while demonstrating no statistically significant evidence of sex differences for levobupivacaine and ropivacaine at the ED50 and ED95 dose ranges, did find a ED50 for ropivacaine 0.5% twice as high for girls (0.64 mg.kg −1 ) as for boys (0.3 mg.kg −1 ) [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Sex differences in pediatric caudal epidural anesthesia under sedation without primary airway instrumentation

et al. 2023

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Study objective To identify sex differences associated with caudal epidurals, the most commonly used technique of pediatric regional anesthesia, based on individually validated data of ultrasound-guided blocks performed between 04/2014 and 12/2020. Methods Prospectively collected and individually validated data of a cohort of children aged between 0–15 years was analyzed in a retrospective observational study. We included pediatric surgeries involving a primary plan of caudal epidural anesthesia under sedation (without airway instrumentation) and a contingency plan of general anesthesia. Sex-specific rates were analyzed for overall failure of the primary anesthesia plan, for residual pain, for block-related technical complications and for critical respiratory events. We used Fisher´s exact tests and multivariable logistic regressions were used to evaluate sex-specific associations. Results Data from 487 girls and 2060 boys ≤15 years old (ASA status 1 to 4) were analyzed. The primary-anesthesia-plan failure rate was 5.5% (95%CI 3.8%-7.8%) (N = 27/487) among girls and 4.7% (95%CI 3.9%-5.7%) (N = 97/2060) among boys (p = 0.41). Residual pain was the main cause of failure, with rates of 4.5% (95%CI 2.9–6.6%) (N = 22/487) among girls and 3.0% (95%CI 2.3–3.8%) (N = 61/2060) among boys (p = 0.089). Block-related technical complications were seen at rates of 0.8% (95%CI 0.3%-1.9%) (N = 4/487) among girls vs 2.5% (95%CI 0.5–2.7%) (N = 51/2060) among boys and, hence, significantly more often among male patients (p = 0.023). Male sex was significantly associated with higher odds (adjusted OR: 3.18; 95% CI: 1.12–9; p = 0.029) for such technical complications regardless of age, ASA status, gestational week at birth or puncture attempts. Critical respiratory events occurred at a 1.7% (95%CI 1.2%-2.3%) rate (N = 35/2060) twice as high among boys as 0.8% (95%CI 0.3%-1.9%) (N = 4/487) among girls (p = 0.21). Conclusions While the the primary-anesthesia-plan failure rate was equal for girls and boys, technical complications and respiratory events are more likely to occur in boys.

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Section: Discussionmentioning

confidence: 99%

Sex differences in pediatric caudal epidural anesthesia under sedation without primary airway instrumentation

et al. 2023

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Infant spinal anesthesia: Do girls need a larger dose of local anesthetic?

Frawley¹,

Huque²

2017

Pediatric Anesthesia

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A sentence in the abstract section "For levobupivacaine, the ED50 (95% CI) was 0.69 (0.49-0.88) mg vs 0.49 (0.33-0.65), whereas the ED95 (95% CI) was 1.07 (0.73-1.41) vs 0.93 (0.64-1.22) for girls and boys, respectively" was erroneously published as "For levobupivacaine, the ED50 (95% CI) was 0.49 (0.33-0.65) mg vs 0.69 (0.49-0.88), whereas the ED95 (95% CI) was 1.07 (0.73-1.41) vs 0.93 (0.64-1.22) for girls and boys, respectively" by

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Spinal anesthesia in children: an educational review

Khrapak,

Everett,

Munshey

2024

Colomb. J. Anesthesiol.

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Despite the well-known benefits of spinal anesthesia (SA), this technique remains underutilized among pediatric anesthesiologists. According to the data from the Pediatric Regional Anesthesia Network, SA accounted for less than 5% of all neuraxial techniques. Some of the factors for underutilization of SA include: Limited duration, unfamiliarity with the technique in younger children, and surgeon preference for general anesthesia. The safe and successful use of SA in children involves recognition of anatomical and physiological differences between adults and children owing to differences in bony structures, spinal cord growth and cerebrospinal fluid physiology. Reports on successful use of SA in children for various surgeries have increased. This educational review summarizes what is known about SA in children, reviews the literature from the last decade and provides suggestions for development of SA in children. Technical considerations, role of ultrasound, guidance on dosing, physiological effects, unexplained aspects of the mechanism of action and combined caudal/SA are discussed.

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Infant spinal anesthesia: Do girls need a larger dose of local anesthetic?

Abstract: There is no evidence that sex differences occur at the ED50 dose range or at the clinically relevant ED95 dose. Modification of spinal anesthetic dose is not required for infant girls.

Cited by 3 publications

References 48 publications

Sex differences in pediatric caudal epidural anesthesia under sedation without primary airway instrumentation

Sex differences in pediatric caudal epidural anesthesia under sedation without primary airway instrumentation

Infant spinal anesthesia: Do girls need a larger dose of local anesthetic?

Spinal anesthesia in children: an educational review

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