Use of spinal anaesthesia in neonates and infants in Antananarivo, Madagascar: a retrospective descriptive study

Abstract

Objective The aim of this study was to present the first cases of spinal anesthesia, in newborns and infants, preterm/ex-prematures, in order to determine its feasibility and its potential harmlessness, in Antananarivo—Madagascar. Indeed, spinal anesthesia is a low cost technique and can limit respiratory complications, postoperative apnea a contrario with pediatric general anesthesia which can lead to perioperative risks. Results In a retrospective, descriptive, 7-year (2013 to 2019) period study, conducted in the University Hospital Joseph Ravoahangy Andrianavalona, 69 patients’ data files planned to have spinal anesthesia were recorded. These pediatric patients were predominantly male (sex ratio = 2.8) and 37 [28–52] days old. The smallest anesthetized child weighed 880 g; the youngest was 4 days old. Twenty-seven (27) of them were premature and 20.3% presented respiratory diseases. They were mostly scheduled for hernia repair (90%). Spinal anesthesia was performed, with a Gauge 25 Quincke spinal needle, after 2 [1–2] attempts with hyperbaric bupivacaine of 4 [3.5–4] mg. Failure rate was 5.8%. The heart rate was stable throughout perioperative period and no complications were observed.

Assessing the Safety and Efficacy of Spinal Anesthesia in Preterm and Term Neonates: A Multicenter Experience

“…Spinal anaesthesia was successful in 96.8%. these findings are similar to studies reported by Randriamizao et [2,6,12,16]. Only 6% of the patients needed conversion to GA.…”

“…This is similar to findings by Williams et al in their study titled the safety and Efficacy of spinal anaesthesia for Surgery in infants [2]. Similar results (94.2%) were obtained by Randriamizao et al, and 95.3% were reported successful by Kachko L et al [6,11] In a meta-analysis to determine whether SA reduces intraoperative and postoperative complications compared with GA, Dorms K et al reported that SA is at least as safe as GA for inguinal hernia repair in preterm neonates [12].…”

“…The majority of our patients (63%) were male, which is similar to studies by Ela AA et al, Randriamizao et al, and Nicola D et al [6,7]. This may not be unconnected with the fact that genitourinary surgeries and herniotomies which form up to 49% of the total procedure we performed are usually more common in the males than the females.…”

“…In 2012, Ilhan et al reported the successful repair of duodenal atresia in a low-birth-weight neonate under SA in Turkey [5]. In 2020, Randriamizao et al in a retrospective study reported the successful use of SA in 69 neonates and infants in Antananarivo, Madagascar [6]. Ela AA et al reported the successful administration of spinal anaesthesia in 55 neonates and infants [7].…”

Urgent surgery for COVID-19–positive pediatric patient

“…New data on the safety and efficacy of anesthesia experiences similar phenomenon. Anesthesiologists should be encouraged regional/neuraxial anesthesia in children continues to emerge from all over the world, even in remote settings such as rural Madagascar [16]. As the field of acute pain management and regional anesthesia continues to grow, the field of pediatric regional anesthesia experiences similar phenomenon.…”