Spinal anaesthesia in children under sedation

Aa Maruf ,Mohammad Zahangir Alam ,Mb Ali ,Sayeda Nazrina

doi:10.3329/mediscope.v4i1.34375

Abstract

Spinal anaesthesia in children evolved more than hundred years ago and gaining considerable popularity worldwide. In our setups in Bangladesh, this technique has not gained popularity yet but over the past few years this technique has been practiced in some centers. The objective of the present study was to observe the efficacy and safety of spinal anaesthesia under sedation in children scheduled for infra-umbilical surgical procedures. In this study, 67 children of age ranging from 2 to 10 years of either sex, with American Society of Anaesthesioloists physical status I and II, undergoing infra-umbilical surgeries were included. Spinal anaesthesia was administered with Quincke 27 gauge needles between L4L5 or L5-S1 interspace in the lateral position under sedation with ketamine and midazolam. Heart rate, mean arterial blood pressure and oxygen saturation (SpO2) were monitored throughout perioperative period. Complications of sedation and spinal anaesthesia were recorded and managed accordingly. Among 67 children, male and female were 62 (92.5%) and 5(7.5%), respectively. The mean (SD) age, body weight, American Society of Anaesthesiologists physical status I and II was 5.2 (2.1) years, 15.5 (4.8) kg, 60 (89.6%) and 7 (10.5%), respectively. Successful spinal anaesthesia was done in all cases. The incidences of side effects of sedation were transient apnoea 1 (1.5%), desaturation (SpO2<93%) 3 (4.5%), stridor 1 (1.5%), laryngospasm 1 (1.5%) and agitation 4 (6.0%). Side effects were transient, self limiting and managed conservatively. Complications of spinal anaesthesia were hypotension 2 (3.0%), bradycardia 1 (1.5%), shivering 1 (1.5%), nausea and vomiting 1 (1.5%) and backache 1 (1.5%). The complications were minor and managed accordingly. There were no serious adverse events reported in any child. The mean (SD) operation time and recovery time from anaesthesia was 49.2 (8.4) minutes and 91.2 (9.2) minutes, respectively. Spinal anaesthesia under sedation with ketamine and midazolam is safe and effective technique for paediatric infraumbilical surgery.Mediscope Vol. 4, No. 1: Jan 2017, Page 18-24

Highlights

The first report on pediatric spinal anesthesia was reported by Bier in 1899, when the technique was performed with cocaine in an 11 year old boy for ischial abscess drainage.[1]
Inclusion criteria were: age- 2 years to 10 years, gender- both male and female, American Society of Anaesthesiologists (ASA) physical status I and II, patients scheduled for elective surgery below umbilicus, parents gave consent for spinal anesthesia, and expected duration of surgery around 60 to 90 minutes
Neonates spinal cord extends at the level of the third lumbar vertebra and, at the end of the first year of life reaches the location seen in adults, at the first lumbar vertebra.[17,18]

Summary

Introduction

The first report on pediatric spinal anesthesia was reported by Bier in 1899, when the technique was performed with cocaine in an 11 year old boy for ischial abscess drainage.[1] In 1900, Bainbridge reported a case of an infant of three months for the repair of a strangulated hernia using spinal anesthesia.[2] In 1909, a detailed procedure of pediatric spinal anesthesia was published by Tyrell-Gray reporting experience from 300 pediatric surgical procedures.[3] By middle of the century, considerable improvement in techniques of general anaesthesia 1. AA Maruf MBBS, FCPS, Department of Anaesthesia & Intensive Care, Border Guard Hospital, Dhaka 2. M Alam, MBBS, MMCPS, FCPS, MRCS, Department of Surgery, Border Guard Hospital, Dhaka 3. MB Ali MBBS, DCH, Department of Pediatrics & Neonatalogy, Cazi Medical College Hospital, Khulna 4. S Nazrina MBBS, MPhil, Assistant Professor, Department of Pharmacology, Armed Forces Medical College, Dhaka

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