Spinal Anaesthesia for Inguinal Hernia Repair in High-Risk Neonates

Webster, A. C.; McKishnie, J. D.; Kenyon, Cynthia F.; Marshall, Donald G.

doi:10.1097/00132586-199112000-00036

Cited by 13 publications

(25 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among major conduction blocks, spinal anesthetic procedures are rarely performed in children, their use being typically restricted to premature and other high-risk infants. [40][41][42][43] The most common major conduction block performed in infants and children is the epidural; although continuous thoracic, lumbar and caudal epidurals are used, the most common epidural block performed in infants and children is the single-shot caudal epidural. [7,8,15] Plexus blocks and other regional anesthetic techniques needing patient cooperation in identifying the nerve require, for the reasons alluded to above, significant technical modifications from the practice in adults, including the use of nerve stimulators to identify nerves.…”

Section: Differences In Regional Anesthesia Practicementioning

confidence: 99%

“…Tetracaine has been used for both spinal [40][41][42][43][83][84][85][86][87] and topical [64,88,89] anesthesia in infants and children. Two consistent themes have emerged from experience with tetracaine spinal anesthesia in infants.…”

Section: Tetracaine (Amethocaine)mentioning

confidence: 99%

“…Early series of tetracaine spinal anesthetic procedures in infants reported tetracaine doses of 0.32 to 0.5 mg/kg (compared with 0.1 to 0.15 mg/kg in adults); [40,41,43,84] more recent series have used tetracaine doses as high as 0.6 to 0.8 mg/kg. [42,[85][86][87] Care must be exercised when using larger tetracaine doses, as changes in the infant's position after the block can result in unacceptably high levels of spinal anesthesia. [90] While tetracaine spinal anesthesia in adults can be expected to last 2 to 3 hours (4 to 6 hours with epinephrine), [76] similar tetracaine spinal anesthetic procedures in infants last only 70 to 85 minutes (<120 minutes with epinephrine).…”

Section: Tetracaine (Amethocaine)mentioning

confidence: 99%

See 2 more Smart Citations

Benefit and Risks of Local Anesthetics in Infants and Children

Gunter

2002

Pediatric Drugs

157

View full text Add to dashboard Cite

Regional anesthesia has become a routine part of the practice of anesthesiology in infants and children. Local anesthetic toxicity is extremely rare in infants and children; however, seizures, dysrhythmias, cardiovascular collapse, and transient neuropathic symptoms have been reported. Infants and children may be at increased risk from local anesthetics compared with adults. Larger volumes of local anesthetics are used for epidural anesthesia in infants and children than in adults. Metabolism and elimination of local anesthetics can be delayed in neonates, who also have decreased plasma concentrations of alpha(1)-acid glycoprotein, leading to increased concentrations of unbound bupivacaine. Most regional anesthetic procedures in infants and children are performed with the patient heavily sedated or anesthetized; because of this, and because a test dose is not a particularly sensitive marker of intravenous injection in the anesthetized patient, detection of intravascular local anesthetic injection is extremely difficult. The same local anesthetics used in adult anesthetic practice are also used in infants and children. Because of its extremely short duration of action, chloroprocaine has been used primarily for continuous epidural techniques in infants and children. The use of tetracaine has generally been limited to spinal and topical anesthesia. Lidocaine (lignocaine) has been used extensively in infants and children for topical, regional, plexus, epidural and spinal anesthesia. The association between prilocaine and methemoglobinemia has generally restricted prilocaine use in infants and children to the eutectic mixture of local anesthetics (EMLA). Because of its greater degree of motor block compared with other long-acting local anesthetics, etidocaine has generally been limited to plexus blocks in infants and children. Mepivacaine has been used for both plexus and epidural anesthesia in infants and children. Because postoperative analgesia is often the primary justification for regional anesthesia in infants and children, bupivacaine, a long-acting local anesthetic, is the most commonly reported local anesthetic for pediatric regional anesthesia. Given the lower toxic threshold of bupivacaine compared with other local anesthetics, the risk-benefit ratio of bupivacaine may be greater than that of other local anesthetics. Two new enantiomerically pure local anesthetics, ropivacaine and levobupivacaine, offer clinical profiles comparable to that of bupivacaine but without its lower toxic threshold. The extreme rarity of major toxicity from local anesthetics suggests that widespread replacement of bupivacaine with ropivacaine or levobupivacaine is probably not necessary. However, there are clinical situations, including prolonged local anesthetic infusions, use in neonates, impaired hepatic metabolic function, and anesthetic techniques requiring a large mass of local anesthetic, where replacement of bupivacaine with ropivacaine, levobupivacaine or (for continuous techniques) chloroprocaine appears prudent.

show abstract

Section: Differences In Regional Anesthesia Practicementioning

confidence: 99%

Section: Tetracaine (Amethocaine)mentioning

confidence: 99%

Section: Tetracaine (Amethocaine)mentioning

confidence: 99%

See 1 more Smart Citation

Benefit and Risks of Local Anesthetics in Infants and Children

Gunter

2002

Pediatric Drugs

157

View full text Add to dashboard Cite

show abstract

“…The first series concerning the use of spinal anaesthesia in children was reported in 1909 ( 1). However, the technique never gained great popularity in paediatric anaesthesia until the 1980s when it was reintroduced as an alternative to general anaesthesia in the high‐risk, former preterm neonate ( 2–6). In this population, spinal anaesthesia was suggested as a means of limiting the incidence of postoperative complications, including apnoea and postoperative respiratory dysfunction ( 7).…”

Section: Introductionmentioning

confidence: 99%

Spinal anaesthesia in infants and children

Tobias

2000

Pediatric Anesthesia

View full text Add to dashboard Cite

“…If surgery is unduly prolonged it may be necessary to supplement the anaesthesia with intravenous sedation, which increases the risk of apnoea. 22 Although several studies have demonstrated the potential safety of spinal anaesthesia,'9-22 monitoring is required for an appropriate period after surgery as the risk of apnoea is still present in these infants.24 25 The advantages of spinal anaesthesia are that it causes minimal physiological disturbance, avoids the risks of general anaesthesia, and allows prompt return to preoperative feeding schedules.…”

mentioning

confidence: 99%

Regional anaesthesia for surgical treatment of inguinal hernia in preterm babies.

Gallagher¹

1993

Archives of Disease in Childhood

View full text Add to dashboard Cite

Spinal Anaesthesia for Inguinal Hernia Repair in High-Risk Neonates

Cited by 13 publications

References 0 publications

Benefit and Risks of Local Anesthetics in Infants and Children

Benefit and Risks of Local Anesthetics in Infants and Children

Spinal anaesthesia in infants and children

Regional anaesthesia for surgical treatment of inguinal hernia in preterm babies.

Contact Info

Product

Resources

About