Spinal anesthesia in 62 premature, former-premature or young infants-technical aspects and pitfalls

Shenkman, Ze’ev; Hoppenstein, David; Litmanowitz, Ita; Shorer, Shy; Gutermacher, Michael; Lazar, Ludvig; Erez, Ilan; Jedeikin, Robert; Freud, Enrique

doi:10.1007/bf03020525

Cited by 49 publications

(31 citation statements)

References 28 publications

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“…O presente estudo confirma achados anteriores relacionados a uma alta taxa de sucesso 2,7 e a baixos índices de apneia, hipoxemia e bradicardia intraoperatórias 2,3,7 e pós-operatórias 1,4,7,8 em recém-nascidos pré-termo submetidos a herniorrafia inguinal com raquianestesia não suplementada. Além disso, demonstramos que a raquianestesia está associada a um baixo índice de complicações pulmonares e nas vias aéreas, entre outras, ao rápido reinício da ingesta oral após cirurgia e à alta hospitalar precoce.…”

Section: Discussionunclassified

“…A raquianestesia foi administrada da forma descrita anteriormente 1 . Noventa minutos antes da cirurgia, foi aplicado 0,5-1 mL de creme EMLA ® (Astra Sodertalje, Suécia) na linha média entre L4 e S1, o qual foi coberto com um curativo oclusivo.…”

Section: Manejo Da Anestesiaunclassified

“…A utilização da raquianestesia durante cirurgias em recém-nascidos pré-termo tem recebido ampla aceitação, porque esse tipo de anestesia é relativamente simples de administrar e apresenta baixo risco de complicações intraoperatórias [1][2][3][4][5][6][7][8] .…”

Section: Introductionunclassified

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Risk factors for spinal anesthesia in preterm infants undergoing inguinal hernia repair

Shenkman¹,

Erez²,

Freud³

et al. 2012

J Pediatr (Rio J)

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Objectives: To investigate the risk factors and incidence of perioperative adverse effects from unsupplemented spinal anesthesia in preterm infants. Times to resumption of oral feeding and to home discharge were also evaluated.Methods: Perioperative data were collected prospectively for all preterm and former preterm infants who underwent inguinal hernia repair with spinal anesthesia at a tertiary medical center. Results:The study group consisted of 144 infants with a median gestational age of 30 weeks, postmenstrual age of 37 weeks, birth weight of 1,420 g, and weight at surgery of 2,140 g. Overall, six (4.2%) infants had intraoperative complications, which included apnea (2/1.4%), bradycardia (2/1.4%), and hypoxemia (4/2.8%). Postoperative complications occurred in 15 (10.4%) infants, mainly hypoxemia (3/2.1%), bradycardia (8/5.5%), and apnea (6/4.1%). Predictive factors of an unfavorable outcome (apnea, resumption of oral feeding > 6 h postoperatively, or discharge > 30 h postoperatively) were bronchopulmonary dysplasia (odds ratio [OR] = 3.2, 95% confidence interval [95%CI] 2.8-5.3; p = 0.01) and periventricular leukomalacia (OR = 2.8, 95%CI 2.1-4.9; p = 0.03). Conclusions:Spinal anesthesia is safe and effective for inguinal hernia repair in preterm infants, with early resumption of oral feeding and short hospitalization. Bronchopulmonary dysplasia and periventricular leukomalacia may pose risks for an unfavorable outcome.J Pediatr (Rio J). 2012;88(3):222-6: Spinal anesthesia, postoperative apnea, oral feeding, hospital discharge, preterm infants. ResumoObjetivos: Investigar os fatores de risco e a incidência de efeitos adversos perioperatórios advindos da raquianestesia não suplementada em recém-nascidos pré-termo. Também foi avaliado o tempo decorrido até o reinício da alimentação oral e até a alta hospitalar. Métodos:Foram coletados prospectivamente os dados perioperatórios de todos os recém-nascidos prematuros e ex-prematuros submetidos a herniorrafia inguinal com raquianestesia em um centro médico terciário.Resultados: O grupo de estudo consistiu em 144 recém-nascidos com uma idade gestacional mediana de 30 semanas, idade concepcional de 37 semanas, peso de nascimento de 1.420 g, e peso de 2.140 g no momento da cirurgia. No total, seis (4,2%) recém-nascidos apresentaram complicações intraoperatórias, que incluíram apneia (2/1,4%), bradicardia (2/1,4%) e hipoxemia (4/2,8%). Complicações pós-operatórias ocorreram em 15 (10,4%) recém-nascidos, principalmente hipoxemia (3/2,1%), bradicardia (8/5,5%) e apneia (6/4,1%). Os fatores preditivos de desfecho desfavorável (apneia, alimentação oral > 6 h de pós-operatório, ou alta > 30 h de pós-operatório) foram displasia broncopulmonar [razão de chances (OR) = 3,2, intervalo de confiança de 95% (IC95%) 2,8-5,3; p = 0,01] e leucomalácia periventricular (OR = 2,8, IC95% 2,1-4,9; p = 0,03). Conclusões:A raquianestesia é segura e eficaz na herniorrafia inguinal em recém-nascidos pré-termo, levando a um reinício precoce da alimentação oral e a um menor período d...

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Section: Discussionunclassified

Section: Manejo Da Anestesiaunclassified

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Risk factors for spinal anesthesia in preterm infants undergoing inguinal hernia repair

Shenkman¹,

Erez²,

Freud³

et al. 2012

J Pediatr (Rio J)

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“…Awake regional techniques in the form of caudal 48,49 or spinal [50][51][52][53][54][55][56] anesthesia have been reported extensively. Many of these studies are case series.…”

Section: Is Regional Anesthesia the Technique Of Choice?mentioning

confidence: 99%

Patient selection in ambulatory anesthesia — An evidence-based review: part II

et al. 2004

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P Pu ur rp po os se e: : This is the second of two reviews evaluating the management of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: diabetes mellitus; morbid obesity; the ex-premature infant; the child with an upper respiratory infection; malignant hyperthermia; and the use of monoamine oxidase inhibitors.S So ou ur rc ce e: : Medline search strategies and the framework for the evaluation of clinical evidence are presented in Part I. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Diabetes mellitus has not been linked with adverse events following ambulatory surgery. The morbidly obese patient is at an increased risk for minor respiratory complications in the perioperative period but these events do not increase unanticipated admissions. The ex-premature infant may be considered for ambulatory surgery if post-conceptual age is > 60 weeks and hematocrit is > 30%. The child with a recent upper respiratory tract infection is at an increased risk for perioperative respiratory complications, particularly if endotracheal intubation is required. Patients with malignant hyperthermia may undergo outpatient surgery but require four hours of postoperative temperature monitoring. Sporadic cases of drug interactions have been reported when meperidine and indirectacting catecholamines are administered in the presence of monamine oxidase inhibitors. Ambulatory anesthesia and surgery is safe if these combinations of drugs are avoided.C Co on nc cl lu us si io on n: : Ambulatory anesthesia can be performed in, and is being offered to, a variety of patients with significant coexistent disease. In many cases there is little evidence documenting the outcomes expected in such patients. Prospective observational and interventional trials are required to better define perioperative management. Objectif : C'est la seconde revue qui évalue la prise en charge de patients, dont les pathologies médicales ont été ciblées, qui doivent subir une anesthésie en chirurgie ambulatoire. Les situations choisies comprennent : le diabète, l'obésité morbide, l'enfant né prématurément, l'enfant atteint d'infection des voies respiratoires supérieures, l'hyperthermie maligne et l'usage d'inhibiteurs de la monoamine-oxydase. Source : Les stratégies de recherche dans Medline et le cadre de l'é-valuation de la preuve clinique sont présentés dans la partie I. Constatations principales : Le diabète n'a pas été relié à des événements indésirables à la suite d'une opération ambulatoire. Le patient très obèse est plus à risque de complications respiratoires péri-opératoires mineures, ce qui n'augmente pas les admissions hospitalières imprévues. L'enfant prématuré est admis en chirurgie ambulatoire si l'âge post-conception est > 60 semaines et si l'hématocrite est > 30 %. L'enfant qui a une infection récente des voies respiratoires supérieures

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“…If a local or regional anesthetic technique is feasible, this may have significant advantages. Spinal 6 or caudal 7 anesthesia are accepted techniques for inguinal hernia repair in infants and regional anesthesia was seriously considered for the patient presented. Even in older children it is possible to perform significant surgery under regional anesthesia.…”

mentioning

confidence: 99%

Repair of incarcerated inguinal hernia in an infant with acute viral bronchiolitis

Cox

2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To describe the anesthetic concerns and management options in an infant with acute viral bronchiolitis who required emergency surgery.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 12-week-old infant presented to the emergency department with an incarcerated right inguinal hernia. The history was complicated by concurrent acute bronchiolitis. As the hernia was irreducible, emergency surgery was required. General endotracheal anesthesia, following a rapid sequence induction, was supplemented with a caudal epidural block. Inhaled salbutamol and suctioning for thick tracheal secretions were required and were found to be clinically useful. The baby made a good postoperative recovery.C Co on nc cl lu us si io on ns s: : A variety of techniques may be used to anesthetize the infant with concurrent acute bronchiolitis. In this case a good outcome was achieved with combined general and regional anesthesia, together with the use of inhaled salbutamol. CUTE viral bronchiolitis is a common respiratory infection in infants. The causal agent is nearly always the respiratory syncytial virus (RSV). It is estimated that approximately 1% of infants with RSV infection will require hospitalization and that these account for more than 125,000 admissions per annum in the United States. 1 The clinical features of RSV bronchiolitis are those of an acute viral illness, characterized by wheezing and respiratory distress. The recovery period may be quite prolonged and residual airway reactivity may persist for months or even years after an infection. 2 In infants in the acute phase of RSV bronchiolitis who require elective surgery, the operation is generally postponed until the infection has resolved. The exact period required before anesthesia can be undertaken is unclear and will depend on many factors, including the urgency of the surgery. Occasionally an infant with active bronchiolitis will present for emergency surgery and some form of anesthesia will be required. ObjectifA case is presented of a 12-week-old baby with moderately severe bronchiolitis, who presented with an incarcerated inguinal hernia. Options for anesthesia are presented and the topic of RSV infection and anesthesia is discussed.C Ca as se e r re ep po or rt t The infant was a 5.1-kg male, born at 37 weeks postconceptual age. There were no neonatal concerns and he was quite well until the age of 12 weeks. At this time, five days prior to admission, he developed a fever, runny nose and congested cough. He was medicated with acetaminophen at home. On the day of presentation the

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Spinal anesthesia in 62 premature, former-premature or young infants-technical aspects and pitfalls

Cited by 49 publications

References 28 publications

Risk factors for spinal anesthesia in preterm infants undergoing inguinal hernia repair

Risk factors for spinal anesthesia in preterm infants undergoing inguinal hernia repair

Patient selection in ambulatory anesthesia — An evidence-based review: part II

Repair of incarcerated inguinal hernia in an infant with acute viral bronchiolitis

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