Document Detail

Combined spinal-epidural anesthesia in major abdominal surgery in high-risk neonates and infants.
MedLine Citation:
PMID:  17897271     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Combined spinal-epidural anesthesia (CSE-A) is reportedly safe and effective for the pediatric population in infraumbilical surgery. Our main purpose was to describe our experience of this technique in neonates and infants undergoing elective major upper abdominal surgery. METHODS: Spinal anesthesia was performed in 28 neonates and infants with isobaric bupivacaine 0.5%, 1 followed by placement of a caudal epidural catheter to thoracic spinal segments. The catheter tip position was confirmed radiographically. Respiratory and hemodynamic data were collected before and after the CSE-A and throughout the operation, as a measure of anesthetic effectiveness. Complications related to the anesthesia technique were collected as a measure of the anesthetic technique safety. RESULTS: Satisfactory surgical anesthesia was achieved in 24 neonates and infants, four patients were converted to general anesthesia. Respiratory and hemodynamic variables did not change significantly during surgery, compared with baseline values: oxygen saturation (P = 0.07), systolic and diastolic blood pressures (P = 0.143, P = 0.198 respectively), heart rate (P = 0.080) and respiratory rate (P = 0.127). However, twenty infants were fussy during the surgical procedures and were calmed with intravenous midazolam; our patients required oxygen supplementation and transient manual ventilation intraoperatively. CONCLUSIONS: Combined spinal-epidural anesthesia could be considered as an effective anesthetic technique for elective major upper abdominal surgery in awake or sedated neonates and infants, and could be used cautiously by a pediatric anesthesiologist as an alternate to general anesthesia in high-risk neonates and infants undergoing upper gastrointestinal surgery.
Mostafa Somri; Riad Tome; Boris Yanovski; Eldar Asfandiarov; Nurit Carmi; Joerge Mogilner; Bader David; Luis A Gaitini
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  17     ISSN:  1155-5645     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-09-27     Completed Date:  2008-01-25     Revised Date:  2009-03-12    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  France    
Other Details:
Languages:  eng     Pagination:  1059-65     Citation Subset:  IM    
Department of Anesthesia, Bnai Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
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MeSH Terms
Anesthesia, Epidural / adverse effects,  instrumentation,  methods*
Anesthesia, Spinal / adverse effects,  instrumentation,  methods*
Blood Pressure / drug effects
Digestive System Surgical Procedures* / classification
Heart Rate / drug effects
Infant, Newborn
Monitoring, Physiologic
Outcome and Process Assessment (Health Care)
Risk Factors
Time Factors
Comment In:
Paediatr Anaesth. 2008 Dec;18(12):1219   [PMID:  19076581 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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