Spinal anesthesia for noncardiac surgery in infants with congenital heart diseases

Kachko, Ludmyla; Birk, Einat; Simhi, Eliahu; Tzeitlin, Elena; Freud, Enrique; Katz, Jacob

doi:10.1111/j.1460-9592.2011.03769.x

Cited by 41 publications

(21 citation statements)

References 25 publications

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“…Despite these data, the potential for hemodynamic changes should always be considered and appropriate monitoring be employed with ready access to resuscitation medications if needed. The potential safety of this approach is further supported by observational studies reporting no clinically significant reduction in blood pressure or oxygen saturation in high-risk infants with CHD during spinal anesthesia (Table 1) [28][29][30][31][32][33][34][35][36]. In these studies in infants and children with CHD, spinal anesthesia provided stable hemodynamic parameters without excessive hypotension requiring the administration of fluid or inotropic agents.…”

Section: Discussionmentioning

confidence: 92%

Spinal Anesthesia for Urologic Surgery in an Infant With Palliated Single Ventricle Physiology

et al. 2016

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Although commonly practiced in the adult population, spinal anesthesia has seen sporadic use in the pediatric population, being employed historically as a means of avoiding apnea following general anesthesia with halothane. With the emergence of evidence that specific anesthetic agents may affect future neurocognitive outcomes, there has been an increased focus on alternatives to general anesthesia, including spinal anesthesia. However, spinal anesthesia may also have applications in patients with co-morbid conditions that increase the risk of general anesthesia. We present the use of spinal anesthesia during urologic surgery in a 19-month-old boy with hypoplastic left heart syndrome who had undergone surgical palliation. The use of spinal anesthesia in patients with congenital heart disease is reviewed, potential hemodynamic consequences are presented, and the use of spinal anesthesia as an alternative to general anesthesia is discussed.

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Section: Discussionmentioning

confidence: 92%

Spinal Anesthesia for Urologic Surgery in an Infant With Palliated Single Ventricle Physiology

et al. 2016

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“…Shenkman et al and Kachko et al [15,41] have reported studies and experiences with spinal anaesthesia in children with congenital heart disease. Researchers consider that spinal anaesthesia is a safe and effective anaesthetic and analgesic technique in patients with CHD especially neonatal period.…”

Section: Figurementioning

confidence: 99%

“…This situation may give rise to an incomplete block. Before injecting local anaesthetic drug, free flow and aspiration of CSF should always be confirmed [11,41]. After free CSF flow is observed, the needle should be forwarded by no more than 1 mm (to avoid subdural injection).…”

Section: Techniquementioning

confidence: 99%

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Spinal Anaesthetic Management in Paediatric Surgery

Caliskan¹

2017

Pediatric and Neonatal Surgery

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The first paediatric cases involving the use of spinal anaesthesia were published at the end of the nineteenth century. However, the technique did not receive much interest in paediatric anaesthesia until the 1980s. In the last three decades, paediatric spinal anaesthesia has received widespread approval as an alternative technique to general anaesthesia in school-/preschool-aged children, particularly in term and preterm neonates with high risk associated with general anaesthesia. The development of new and safer local anaesthetics mainly through better understanding of the pharmacokinetics and dynamics and dedicated paediatric tools are the keys to this success. Paediatric spinal anaesthesia is an easy and effective technique, and its high efficiency and safety are supported by the presence of numerous publications from the medical literature. However, it remains limited to situations in which general anaesthesia poses a major risk. Despite these advances, it is important to understand the correct technique and the anatomy of children at different ages. Also, the appropriate equipment, the pharmacokinetics and toxicities of local anaesthetics and the indications and complications of paediatric regional blocks should be well known. The goal of this chapter is to review and discuss some of these topics of paediatric spinal anaesthesia for paediatric surgery.

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“…1,2 Large case series report safe and effective anesthesia and analgesia, 3–8 including use in high risk infants. 9,10 Neuraxial anesthesia may have particular advantages in preterm-born neonates who are susceptible to postoperative apnoea or have co-existing respiratory disease. 1,11,12 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of Spinal Toxicity and Long-term Spinal Reflex Function after Intrathecal Levobupivaciane in the Neonatal Rat

et al. 2013

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Background Neuraxial anesthesia is utilized in children of all ages. Local anesthetics produce dose-dependent toxicity in certain adult models, but the developing spinal cord may also be susceptible to drug-induced apoptosis. In postnatal rodents, we examined effects of intrathecal levobupivacaine on neuropathology and long-term sensorimotor outcomes. Methods Postnatal day 3 (P3) or P7 rat pups received intrathecal levobupivacaine 2.5mg/kg (0.5%) or saline. Mechanical withdrawal thresholds and motor block were assessed. Spinal cord tissue analysis included: apoptosis counts (activated-caspase-3, Fluoro-Jade C) at 24 h; glial reactivity at 7 days; and histopathology in cord and cauda equina at 24 h and 7 days. Long-term spinal function in young adults (P35) was assessed by hindlimb withdrawal thresholds, electromyography responses to suprathreshold stimuli, and gait analysis. Results Intrathecal levobupivacaine produced spinal anesthesia at P3 and P7. No increase in apoptosis or histopathological change was seen in the cord or cauda equina. In the P3 saline group, activated-caspase-3 (mean±SEM per lumbar cord section 6.1±0.3) and Fluoro-Jade C (12.1±1.2) counts were higher than at P7, but were not altered by levobupivacaine (P=0.62 and P=0.11, two-tailed Mann-Whitney test). At P35, mechanical withdrawal thresholds, thermal withdrawal latency and electromyographic reflex responses did not differ across P3 or P7 levobupivacaine or saline groups (one way ANOVA with Bonferroni comparisons). Intrathecal bupivacaine at P3 did not alter gait. Conclusion Single dose intrathecal levobupivacaine 0.5% did not increase apoptosis or produce spinal toxicity in neonatal rat pups. This study provides preclinical safety data relevant to neonatal use of neuraxial local anesthesia.

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Spinal anesthesia for noncardiac surgery in infants with congenital heart diseases

Cited by 41 publications

References 25 publications

Spinal Anesthesia for Urologic Surgery in an Infant With Palliated Single Ventricle Physiology

Spinal Anesthesia for Urologic Surgery in an Infant With Palliated Single Ventricle Physiology

Spinal Anaesthetic Management in Paediatric Surgery

Evaluation of Spinal Toxicity and Long-term Spinal Reflex Function after Intrathecal Levobupivaciane in the Neonatal Rat

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