| Combined spinal-epidural anesthesia in major abdominal surgery in high-risk neonates and infants. | |
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MedLine Citation:
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PMID: 17897271 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 mg.kg(-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. |
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Authors:
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Mostafa Somri; Riad Tome; Boris Yanovski; Eldar Asfandiarov; Nurit Carmi; Joerge Mogilner; Bader David; Luis A Gaitini |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Paediatric anaesthesia Volume: 17 ISSN: 1155-5645 ISO Abbreviation: Paediatr Anaesth Publication Date: 2007 Nov |
Date Detail:
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Created Date: 2007-09-27 Completed Date: 2008-01-25 Revised Date: 2009-03-12 |
Medline Journal Info:
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Nlm Unique ID: 9206575 Medline TA: Paediatr Anaesth Country: France |
Other Details:
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Languages: eng Pagination: 1059-65 Citation Subset: IM |
Affiliation:
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Department of Anesthesia, Bnai Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. somri_m@yahoo.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anesthesia, Epidural
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adverse effects,
instrumentation,
methods* Anesthesia, Spinal / adverse effects, instrumentation, methods* Blood Pressure / drug effects Digestive System Surgical Procedures* / classification Female Heart Rate / drug effects Humans Infant Infant, Newborn Male Monitoring, Physiologic Outcome and Process Assessment (Health Care) Risk Factors Time Factors |
| Comments/Corrections | |
Comment In:
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Paediatr Anaesth. 2008 Dec;18(12):1219
[PMID:
19076581
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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