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Awake spinal or caudal anaesthesia in preterms for herniotomies: what is the evidence based benefit compared with general anaesthesia?
MedLine Citation:
PMID:  17021477     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Postoperative apnoea is known to threaten preterm and ex-preterm infants undergoing surgery for inguinal hernia. Awake regional anaesthesia, initially spinal and later caudal anaesthesia have been suggested as effective techniques to avoid these complications. However, most herniotomies in this group of patients are still performed under general anaesthesia without deleterious consequences. Whereas some experts continue to claim advantages for awake regional over general anaesthesia for preterm infants, others consider awake regional anaesthesia to be an exclusive, technically difficult and unreliable technique of unconfirmed benefit. RECENT FINDINGS: It is appropriate to weigh the scarce available evidence that has been accumulated since 1984, and put it into perspective with new developments in paediatric general anaesthesia. The actual clinical significance of postoperative apnoea and improvements in neonatal and perioperative care and monitoring must also be reconsidered. SUMMARY: The available evidence does not allow unequivocal conclusions to be drawn or recommendations to be made. Awake regional anaesthesia for herniotomies in preterm infants has been found to be superior in most studies; however, it requires technical expertise and dedication on the part of the anaesthetist and surgeon. When light general anaesthesia with modern anaesthetic agents such as sevoflurane or desflurane is combined with a caudal block, postoperative apnoea is very rare, and can easily be recognized and managed with good postoperative monitoring and therapy.
Authors:
Andreas C Gerber; Markus Weiss
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current opinion in anaesthesiology     Volume:  16     ISSN:  0952-7907     ISO Abbreviation:  Curr Opin Anaesthesiol     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2006-10-05     Completed Date:  2007-06-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8813436     Medline TA:  Curr Opin Anaesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  315-20     Citation Subset:  -    
Affiliation:
Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland. andreas.gerber@kispi.unizh.ch
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