Document Detail

Lumbar epidural anaesthesia for inguinal hernia repair in low birth weight infants.
MedLine Citation:
PMID:  8403142     Owner:  NLM     Status:  MEDLINE    
In view of the complications of general, spinal, and caudal anaesthesia for inguinal hernia repair in high-risk neonates, an evaluation of lumbar epidural anaesthesia (LEA) was undertaken to assess its technical feasibility, effectiveness and incidence of complications. In 18 consecutive cases, gestational age 26 +/- 2.6 wk, birth weight 877 +/- 310 g, 16 (89%) had bronchopulmonary dysplasia and 12 (67%) were oxygen-dependent at the time of surgery. Using a standard loss of resistance technique and a 4.0 cm 20 G epidural needle, the epidural space was positively identified on the first attempt in 16 (89%), and on the second attempt in 2 patients (11%). Reflux of 0.9% saline used to identify the epidural space was blood tinged in two cases. Epidural analgesia was achieved in all cases with bupivacaine 0.25% with and without 1:200,000 epinephrine, 0.75 for the first two cases, and subsequently 1.0 In 15 patients (83%), good operating conditions were achieved with epidural analgesia alone. Inhalational anaesthesia supplementation was necessary in three cases (17%). In the first two patients, the level of analgesia (T8) was insufficient to control the response to traction on the hernial sac. In one infant, analgesic to T4, whose surgery was inadvertently delayed for four hours, inhalation anaesthesia was needed to control restlessness rather than pain. Ten infants were analgesic to T2, four to T4, two to T6 and two to T8. Intraoperative periodic breathing was seen in seven infants (39%), four with oxyhaemoglobin desaturation to 75%, and two to 85%. All responded to increased FIO2.(ABSTRACT TRUNCATED AT 250 WORDS)
A C Webster; J D McKishnie; J T Watson; W D Reid
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  40     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  1993 Jul 
Date Detail:
Created Date:  1993-11-18     Completed Date:  1993-11-18     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  670-5     Citation Subset:  IM    
Department of Anaesthesia, University of Western Ontario, St. Joseph's Health Centre, London.
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MeSH Terms
Analgesia, Epidural
Anesthesia, Epidural*
Anesthesia, Inhalation
Bupivacaine / administration & dosage
Hernia, Inguinal / surgery*
Infant, Low Birth Weight*
Infant, Newborn
Infant, Premature*
Infant, Premature, Diseases / surgery*
Lumbar Vertebrae
Reg. No./Substance:

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