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Paediatric spinal anaesthesia: Difference between revisions
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→APPLICATIONS OF SPINAL ANAESTHESIA
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SA remains popular for ex-premature infants, specifically those undergoing inguinal herniorraphy. These patients often have a history of apnoea of prematurity, bronchopulmonary dysplasia and chronic lung disease. The incidence of postoperative apnoeas correlates with gestational age at birth, the post-conceptional age at surgery, weight, anaemia and a history of apnoeas. General anaesthesia increases the risk of apnoea and bradycardia, and ex-premature infants remain at risk until after 60 weeks post- conception.<ref>Welborn LG, Rice LJ, Hannalah RS, Broadman LM, Ruttimann VE, Fink R. Post-operative apnea in former infants: prospective comparison of spinal and general anesthesia. Anesthesiology 1990; 72: 838-42.</ref><sup>,</sup><ref>Tobias JD. Spinal anaesthesia in infants and children. Paediatric Anaesth 2000; 10: 5-16.</ref> | SA remains popular for ex-premature infants, specifically those undergoing inguinal herniorraphy. These patients often have a history of apnoea of prematurity, bronchopulmonary dysplasia and chronic lung disease. The incidence of postoperative apnoeas correlates with gestational age at birth, the post-conceptional age at surgery, weight, anaemia and a history of apnoeas. General anaesthesia increases the risk of apnoea and bradycardia, and ex-premature infants remain at risk until after 60 weeks post- conception.<ref>Welborn LG, Rice LJ, Hannalah RS, Broadman LM, Ruttimann VE, Fink R. Post-operative apnea in former infants: prospective comparison of spinal and general anesthesia. Anesthesiology 1990; 72: 838-42.</ref><sup>,</sup><ref>Tobias JD. Spinal anaesthesia in infants and children. Paediatric Anaesth 2000; 10: 5-16.</ref> | ||
Outside the neonatal period, SA has been used for general surgery (rectal biopsy, incision of rectal abscess), urological surgery (orchidopexy, circumcision), lower limb orthopaedic surgery,<ref>Dalens B, Veyckemans F. Traité d’Anesthésie Loco-Régionale, de la naissance à l’âge adulte. Montpellier: Sauramps Médical 2008, 463-512.</ref><sup>,</sup> and may be of particular use in developing countries as an alternative to general anaesthesia. | Outside the neonatal period, SA has been used for general surgery (rectal biopsy, incision of rectal abscess), urological surgery (orchidopexy, circumcision), lower limb orthopaedic surgery,<ref name=":5">Dalens B, Veyckemans F. Traité d’Anesthésie Loco-Régionale, de la naissance à l’âge adulte. Montpellier: Sauramps Médical 2008, 463-512.</ref><sup>,</sup> and may be of particular use in developing countries as an alternative to general anaesthesia. | ||
SA has also been suggested for patients in whom GA may pose a significant risk such as those with facial dysmorphia and difficult intubation, muscular dystrophy, family history of malignant hyperthermia or a full stomach with aspiration risk.<ref name=":5" /> | SA has also been suggested for patients in whom GA may pose a significant risk such as those with facial dysmorphia and difficult intubation, muscular dystrophy, family history of malignant hyperthermia or a full stomach with aspiration risk.<ref name=":5" /> | ||
SA has also been described in combination with GA in children undergoing complex surgery. For instance, preoperative morphine SA combined with GA for scoliosis surgery is associated with reduced blood loss and better pain control.6,7 SA has been used with GA during cardiopulmonary bypass in neonates to blunt the stress response, protect hemodynamic status and reduce perioperative morbidity and mortality,4,9 although its use in this situation is not common. SA has also been described for use in chronic pain management.4,8 | SA has also been described in combination with GA in children undergoing complex surgery. For instance, preoperative morphine SA combined with GA for scoliosis surgery is associated with reduced blood loss and better pain control.6,7 SA has been used with GA during cardiopulmonary bypass in neonates to blunt the stress response, protect hemodynamic status and reduce perioperative morbidity and mortality,4,9 although its use in this situation is not common. SA has also been described for use in chronic pain management.4,8 | ||