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Paediatric spinal anaesthesia: Difference between revisions
→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;5 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). 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. | 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). | ||
Lumbar puncture is performed at L3-L4 or L4-L5 level. Various sizes and lengths of needles are available depending on the child’s age. We use a 25G or 26G needle with stylet for neonates and infants (Figure 2). Using a needle without a stylet is not recommended since epithelial tissue can be deposited in the intrathecal space and may cause dermoid tumours of the neural axis. | |||
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. | |||
Lumbar puncture is performed at L3-L4 or L4-L5 level. Various sizes and lengths of needles are available depending on the child’s age. We use a 25G or 26G needle with stylet for neonates and infants (Figure 2). [[File:SpinalNeedlesforSA.jpg|right|thumb|500x500px|Figure 2. <i>Different types of SA needles</i>]] Using a needle without a stylet is not recommended since epithelial tissue can be deposited in the intrathecal space and may cause dermoid tumours of the neural axis. | |||
A free flow of cerebrospinal fluid should be obtained when the spinal needle is advanced into the intrathecal space. The local anaesthetic syringe is attached and the anaesthetic solution is injected over 30 seconds (Figure 3). The legs should not be lifted after the spinal injection has been administered, otherwise an excessively high block will develop. | A free flow of cerebrospinal fluid should be obtained when the spinal needle is advanced into the intrathecal space. The local anaesthetic syringe is attached and the anaesthetic solution is injected over 30 seconds (Figure 3). The legs should not be lifted after the spinal injection has been administered, otherwise an excessively high block will develop. | ||