Paediatric spinal anaesthesia - Revision history

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REFERENCES

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	== REFERENCES ==		== REFERENCES ==

	Troncin R, Dadure C. Paediatric spinal anaesthesia. Update in Anaesthesia (2009);25(1):22-24 ~~Available from: http://www.wfsahq.org/components/ com_virtual_library/media/b11bcbd8ca5b2fcdd6762e26503838b0- bd58f3feb0a0db474a5ea3c41f4f0431-Paediatric-Spinal-Anaesthesia.pdf~~		[https://resources.wfsahq.org/wp-content/uploads/uia30-Paediatric-spinal-anaesthesia.pdf Troncin R, Dadure C. Paediatric spinal anaesthesia. Update in Anaesthesia (2009);25(1):22-24]

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	[[File:Wfsahq-logo.png\|200px\|thumb\|right]]		[[File:Wfsahq-logo.png\|200px\|thumb\|right]]
	~~This page is under construction, converting the originally formatted pdf from the WFSA site with wiki embellishments.~~

	''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''		''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''

WikiSysop: /* REFERENCES */

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REFERENCES

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	Troncin R, Dadure C. Paediatric spinal anaesthesia. Update in Anaesthesia (2009);25(1):22-24 Available from: http://www.wfsahq.org/components/ com_virtual_library/media/b11bcbd8ca5b2fcdd6762e26503838b0- bd58f3feb0a0db474a5ea3c41f4f0431-Paediatric-Spinal-Anaesthesia.pdf		Troncin R, Dadure C. Paediatric spinal anaesthesia. Update in Anaesthesia (2009);25(1):22-24 Available from: http://www.wfsahq.org/components/ com_virtual_library/media/b11bcbd8ca5b2fcdd6762e26503838b0- bd58f3feb0a0db474a5ea3c41f4f0431-Paediatric-Spinal-Anaesthesia.pdf


	~~15. Disma N, Tuo P, Astuto M, Davidson AJ. Depth of sedation using cerebral index in infants undergoing spinal anaesthesia. Pediatric Anesthesia 2009; 19: 133-7.~~

	~~16. Wee LH, Lam F, Cranston AJ. The incidence of post dural puncture headache in children. Anaesthesia 1996; 51: 1164-6.~~

WikiSysop: /* COMPLICATIONS OF SA */

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COMPLICATIONS OF SA

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	:• Respiratory (+/-cardiovascular) insufficiency due to high SA or secondary to intravenous sedation. Resuscitation measures must be taken (ABC) - tracheal intubation and volume resuscitation may be required.		:• Respiratory (+/-cardiovascular) insufficiency due to high SA or secondary to intravenous sedation. Resuscitation measures must be taken (ABC) - tracheal intubation and volume resuscitation may be required.
	:• Convulsions due to overdose of local anaesthetic. All doses should be calculated carefully and checked with another practitioner.		:• Convulsions due to overdose of local anaesthetic. All doses should be calculated carefully and checked with another practitioner.
	:• Postduralpunctureheadache. Thishasbeenreportedinchildren>8 years old, but the incidence in younger children is unknown, in part since headaches in infants and young children are difficult to assess.<ref name=":5" /><sup>,</sup><ref> 16</ref><sup>,</sup>		:• Postduralpunctureheadache. Thishasbeenreportedinchildren>8 years old, but the incidence in younger children is unknown, in part since headaches in infants and young children are difficult to assess.<ref name=":5" /><sup>,</sup><ref>Wee LH, Lam F, Cranston AJ. The incidence of post dural puncture headache in children. Anaesthesia 1996; 51: 1164-6.</ref><sup>,</sup>
	:• Infectious complications such as meningitis. The incidence of meningitis is very low – careful aseptic technique must be used at all times and multidose ampuoles of local anaesthetic must never be used. We suggest repeating lumbar puncture in patients who develop fever after SA.4,5		:• Infectious complications such as meningitis. The incidence of meningitis is very low – careful aseptic technique must be used at all times and multidose ampuoles of local anaesthetic must never be used. We suggest repeating lumbar puncture in patients who develop fever after SA.4,5
	:• Neurological injury due to injection of incorrect solutions. Great care must be taken at all times in preparation and checking of drugs.		:• Neurological injury due to injection of incorrect solutions. Great care must be taken at all times in preparation and checking of drugs.

WikiSysop: /* COMPLICATIONS OF SA */

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COMPLICATIONS OF SA

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	:• Respiratory (+/-cardiovascular) insufficiency due to high SA or secondary to intravenous sedation. Resuscitation measures must be taken (ABC) - tracheal intubation and volume resuscitation may be required.		:• Respiratory (+/-cardiovascular) insufficiency due to high SA or secondary to intravenous sedation. Resuscitation measures must be taken (ABC) - tracheal intubation and volume resuscitation may be required.
	:• Convulsions due to overdose of local anaesthetic. All doses should be calculated carefully and checked with another practitioner.		:• Convulsions due to overdose of local anaesthetic. All doses should be calculated carefully and checked with another practitioner.
	:• Postduralpunctureheadache. Thishasbeenreportedinchildren>8 years old, but the incidence in younger children is unknown, in part since headaches in infants and young children are difficult to assess.5,16		:• Postduralpunctureheadache. Thishasbeenreportedinchildren>8 years old, but the incidence in younger children is unknown, in part since headaches in infants and young children are difficult to assess.<ref name=":5" /><sup>,</sup><ref> 16</ref><sup>,</sup>
	:• Infectious complications such as meningitis. The incidence of meningitis is very low – careful aseptic technique must be used at all times and multidose ampuoles of local anaesthetic must never be used. We suggest repeating lumbar puncture in patients who develop fever after SA.4,5		:• Infectious complications such as meningitis. The incidence of meningitis is very low – careful aseptic technique must be used at all times and multidose ampuoles of local anaesthetic must never be used. We suggest repeating lumbar puncture in patients who develop fever after SA.4,5
	:• Neurological injury due to injection of incorrect solutions. Great care must be taken at all times in preparation and checking of drugs.		:• Neurological injury due to injection of incorrect solutions. Great care must be taken at all times in preparation and checking of drugs.

WikiSysop: /* TECHNIQUE OF SA IN CHILDREN */

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TECHNIQUE OF SA IN CHILDREN

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	[[File:LumbarPuntureforSA.jpg\|left\|thumb\|500x500px\|Figure 3. <i>Lumbar puncture and LA injection with 1ml syringe</i>]]		[[File:LumbarPuntureforSA.jpg\|left\|thumb\|500x500px\|Figure 3. <i>Lumbar puncture and LA injection with 1ml syringe</i>]]

	SA may produce a degree of sedation in newborns and infants so additional intravenous sedation is not required.<ref>15</ref><sup>,</~~ref~~> Intravenous sedation should be avoided if at all possible in infants at risk of apnoea. We find that a dummy dipped in sucrose or honey will help to settle these infants.		SA may produce a degree of sedation in newborns and infants so additional intravenous sedation is not required.<ref>Disma N, Tuo P, Astuto M, Davidson AJ. Depth of sedation using cerebral index in infants undergoing spinal anaesthesia. Pediatric Anesthesia 2009; 19: 133-7.</ref><sup>,</sup> Intravenous sedation should be avoided if at all possible in infants at risk of apnoea. We find that a dummy dipped in sucrose or honey will help to settle these infants.

	<i>Postoperative care</i>		<i>Postoperative care</i>

WikiSysop: /* TECHNIQUE OF SA IN CHILDREN */

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TECHNIQUE OF SA IN CHILDREN

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	[[File:LumbarPuntureforSA.jpg\|left\|thumb\|500x500px\|Figure 3. <i>Lumbar puncture and LA injection with 1ml syringe</i>]]		[[File:LumbarPuntureforSA.jpg\|left\|thumb\|500x500px\|Figure 3. <i>Lumbar puncture and LA injection with 1ml syringe</i>]]

	SA may produce a degree of sedation in newborns and infants so additional intravenous sedation is not required.15 Intravenous sedation should be avoided if at all possible in infants at risk of apnoea. We find that a dummy dipped in sucrose or honey will help to settle these infants.		SA may produce a degree of sedation in newborns and infants so additional intravenous sedation is not required.<ref>15</ref><sup>,</ref> Intravenous sedation should be avoided if at all possible in infants at risk of apnoea. We find that a dummy dipped in sucrose or honey will help to settle these infants.

	<i>Postoperative care</i>		<i>Postoperative care</i>

WikiSysop: /* TECHNIQUE OF SA IN CHILDREN */

2023-02-09T00:38:21Z

TECHNIQUE OF SA IN CHILDREN

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	The operator should use sterile gloves, gown and mask and the patient’s skin should be cleaned with an alcoholic solution such as 0.5% or 2% chlorhexidine (+/- iodine). The skin should be allowed to dry and a sterile sheet should be placed over the child with a hole to reveal the field. The dose of local anaesthetic solution is calculated according to the weight of the child and is shown in Table 2;<ref name=":5" /><sup></sup> the drugs should be drawn into a 1-2ml syringe as appropriate and placed on the sterile work surface in preparation for use.		The operator should use sterile gloves, gown and mask and the patient’s skin should be cleaned with an alcoholic solution such as 0.5% or 2% chlorhexidine (+/- iodine). The skin should be allowed to dry and a sterile sheet should be placed over the child with a hole to reveal the field. The dose of local anaesthetic solution is calculated according to the weight of the child and is shown in Table 2;<ref name=":5" /><sup></sup> the drugs should be drawn into a 1-2ml syringe as appropriate and placed on the sterile work surface in preparation for use.

	Both the sitting or lateral decubitus position have been described for lumbar puncture.4,5 We have great experience of the lateral position for awake neonates or infants but careful attention must be directed at maintaining patency of the airway which may be compromised with overzealous positioning (Figure 1).		Both the sitting or lateral decubitus position have been described for lumbar puncture.<ref name=":4" /><sup>,</sup><ref name=":5" /><sup>,</sup> We have great experience of the lateral position for awake neonates or infants but careful attention must be directed at maintaining patency of the airway which may be compromised with overzealous positioning (Figure 1).

	The lateral position may be easier than the sitting position for older patients for whom intravenous sedation with a benzodiazepine such as midazolam may be indicated.		The lateral position may be easier than the sitting position for older patients for whom intravenous sedation with a benzodiazepine such as midazolam may be indicated.

WikiSysop: /* TECHNIQUE OF SA IN CHILDREN */

2023-02-09T00:36:38Z

TECHNIQUE OF SA IN CHILDREN

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	The operator should use sterile gloves, gown and mask and the patient’s skin should be cleaned with an alcoholic solution such as 0.5% or 2% chlorhexidine (+/- iodine). The skin should be allowed to dry and a sterile sheet should be placed over the child with a hole to reveal the field. The dose of local anaesthetic solution is calculated according to the weight of the child and is shown in Table 2;5 the drugs should be drawn into a 1-2ml syringe as appropriate and placed on the sterile work surface in preparation for use.		The operator should use sterile gloves, gown and mask and the patient’s skin should be cleaned with an alcoholic solution such as 0.5% or 2% chlorhexidine (+/- iodine). The skin should be allowed to dry and a sterile sheet should be placed over the child with a hole to reveal the field. The dose of local anaesthetic solution is calculated according to the weight of the child and is shown in Table 2;<ref name=":5" /><sup></sup> the drugs should be drawn into a 1-2ml syringe as appropriate and placed on the sterile work surface in preparation for use.

	Both the sitting or lateral decubitus position have been described for lumbar puncture.4,5 We have great experience of the lateral position for awake neonates or infants but careful attention must be directed at maintaining patency of the airway which may be compromised with overzealous positioning (Figure 1).		Both the sitting or lateral decubitus position have been described for lumbar puncture.4,5 We have great experience of the lateral position for awake neonates or infants but careful attention must be directed at maintaining patency of the airway which may be compromised with overzealous positioning (Figure 1).

WikiSysop: /* REFERENCES */

2023-02-09T00:33:42Z

REFERENCES

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	Troncin R, Dadure C. Paediatric spinal anaesthesia. Update in Anaesthesia (2009);25(1):22-24 Available from: http://www.wfsahq.org/components/ com_virtual_library/media/b11bcbd8ca5b2fcdd6762e26503838b0- bd58f3feb0a0db474a5ea3c41f4f0431-Paediatric-Spinal-Anaesthesia.pdf		Troncin R, Dadure C. Paediatric spinal anaesthesia. Update in Anaesthesia (2009);25(1):22-24 Available from: http://www.wfsahq.org/components/ com_virtual_library/media/b11bcbd8ca5b2fcdd6762e26503838b0- bd58f3feb0a0db474a5ea3c41f4f0431-Paediatric-Spinal-Anaesthesia.pdf


	~~14. Mahe V, Ecoffey C. Spinal anesthesia with isobaric bupivacaine in infants. Anesthesiology 1988; 68: 601-3.~~

	15. Disma N, Tuo P, Astuto M, Davidson AJ. Depth of sedation using cerebral index in infants undergoing spinal anaesthesia. Pediatric Anesthesia 2009; 19: 133-7.		15. Disma N, Tuo P, Astuto M, Davidson AJ. Depth of sedation using cerebral index in infants undergoing spinal anaesthesia. Pediatric Anesthesia 2009; 19: 133-7.

	16. Wee LH, Lam F, Cranston AJ. The incidence of post dural puncture headache in children. Anaesthesia 1996; 51: 1164-6.		16. Wee LH, Lam F, Cranston AJ. The incidence of post dural puncture headache in children. Anaesthesia 1996; 51: 1164-6.