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An 11 month old baby boy is presenting for umbilical hernia repair. The<br />
medical student asks how spinal anesthesia is different in the infant when<br />
compared to the adult. You can confidently say all of the following EXCEPT:<br />
<br />
a) The conus medularis terminates at L1 for most adults<br />
<br />
b) The conus medularis terminates at L4 in most infants<br />
<br />
c) The dural sac terminates at S1 in adults<br />
<br />
d) The dural sac terminates at S3 in infants<br />
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==Answer==<br />
Answer b. The conus medularis terminates at L2-L3 in most infants (1).<br />
Differential rates of growth for the developing human spinal cord and spinal<br />
column create changing relationships between these two structures. Spinal<br />
anesthesia (as with lumbar puncture) should target the dural puncture to be<br />
inferior to the conus medularis, yet superior to the termination of the dural sac.<br />
This position minimizes trauma to neural tissue, yet still provides access to the<br />
CSF spaces. In infants, the conus medularis terminates at the L2-L3 space; in<br />
adults the termination is usually at L1. The more cephalad position of the sacrum<br />
and the relatively smaller pelvis position the dural sac closer to S3 in infants.<br />
This increases the likelihood of a dural puncture when providing caudal<br />
anesthesia.<br />
==Notes==<br />
<references /><br />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.<br />
==Keywords==<br />
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