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Paediatric spinal anaesthesia: Difference between revisions
→APPLICATIONS OF SPINAL ANAESTHESIA
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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. | 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.<ref name=":6">Dalens B, Tanguy A. Intrathecal morphine for spinal fusion in children. Spine 1988: 13: 494-7.</ref><sup>,</sup><ref name=":7">Gall O, Aubineau JV, Bernière J, Desjeux L, Murat I. Analgesic effect of low dose intrathecal morphine after spinal infusion in children. Anesthesiology 2001; 94: 447-52</ref><sup>,</sup> 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,<ref name=":4" /><sup>,</sup><ref name=":8">Berde C, Sethna N, Conrad LS, Hershenson MB. Subarachnoid bupivacaine analgesia for seven months for a patient with a spinal cord tumour. Anesthesiology 1990; 72: 1094-6.</ref><sup>,</sup><ref name=":4" /><sup>,</sup><ref name=":9"> | 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.<ref name=":6">Dalens B, Tanguy A. Intrathecal morphine for spinal fusion in children. Spine 1988: 13: 494-7.</ref><sup>,</sup><ref name=":7">Gall O, Aubineau JV, Bernière J, Desjeux L, Murat I. Analgesic effect of low dose intrathecal morphine after spinal infusion in children. Anesthesiology 2001; 94: 447-52</ref><sup>,</sup> 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,<ref name=":4" /><sup>,</sup><ref name=":8">Berde C, Sethna N, Conrad LS, Hershenson MB. Subarachnoid bupivacaine analgesia for seven months for a patient with a spinal cord tumour. Anesthesiology 1990; 72: 1094-6.</ref><sup>,</sup><ref name=":4" /><sup>,</sup><ref name=":9">Kowalewski R, MacAdams C, Froelich J, Neil S, Maitland A. Anesthesia supplemented with subarachnoid bupivacaine and morphine for coronary artery bypass surgery in a child with Kawasaki disease. J cardiothor Vasc Anesth 1996; 10: 243-6</ref><sup>,</sup> although its use in this situation is not common. SA has also been described for use in chronic pain management.4,8 | ||
== CONTRAINDICATIONS TO SA == | == CONTRAINDICATIONS TO SA == | ||