Kachko Ludmyla, Simhi Eliahu, Tzeitlin Elena, Efrat Rachel, Tarabikin Evelina, Peled Elia, Metzner Iulia, Katz Jacob
Department of Anesthesia, Schneider Children's Medical Center of Israel, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Paediatr Anaesth. 2007 Jul;17(7):647-53. doi: 10.1111/j.1460-9592.2007.02194.x.
Our aim was to assess the safety and efficacy of spinal anesthesia (SA) in newborns and infants undergoing surgery appropriate for this technique.
The files of 505 patients who underwent surgery under spinal anesthesia since 1998 at a major tertiary hospital in Israel were analyzed retrospectively. SA was performed with bupivacaine 5 mgxml(-1) by attending pediatric anesthesiologists or an anesthesia resident. Demographic data, prematurity history, comorbidities, technical data, cardiovascular stability, complications and supplementary drugs were documented. The surgeon assessed the quality of anesthesia at the end of surgery.
Appropriate SA was achieved in 95.3% of cases; in 69.9% at the first attempt. The mean number of attempts per patient was 1.41 and mean dose of bupivacaine was 0.66 +/- 0.16 mgxkg(-1). Intravenous sedation, usually with midazolam (dose 0.1-0.2 mgxkg(-1)) was required in 28.1% of children because of crying/restlessness. Intraoperative conversion to general anesthesia was necessary in five patients (1.04%). The main side effect was bradycardia (<100 bxmin(-1)) without desaturation which occurred in nine patients (1.8%). In three patients (0.62%), high spinal block occurred without bradycardia and hypotension. None of the patients had postoperative meningitis.
SA is safe and effective in newborns and infants undergoing low abdominal, perineal and orthopedic surgery. In order to save time, our advice is to attempt SA after the surgeon is scrubbed, and minimize surgical teaching activity. The need to deal with a small and sometimes sick patient independent of the type of anesthesia requires the presence of an experienced pediatric anesthesiologist.
我们的目的是评估脊髓麻醉（SA）在接受适合该技术手术的新生儿和婴儿中的安全性和有效性。
回顾性分析自1998年以来在以色列一家大型三级医院接受脊髓麻醉手术的505例患者的病历。由主治儿科麻醉医生或麻醉住院医生使用5mg/ml的布比卡因进行脊髓麻醉。记录人口统计学数据、早产史、合并症、技术数据、心血管稳定性、并发症和辅助药物。外科医生在手术结束时评估麻醉质量。
95.3%的病例成功实施了适当的脊髓麻醉；首次尝试成功率为69.9%。每位患者的平均尝试次数为1.41次，布比卡因的平均剂量为0.66±0.16mg/kg。28.1%的儿童因哭闹/躁动需要静脉镇静，通常使用咪达唑仑（剂量0.1 - 0.2mg/kg）。5例患者（1.04%）术中需要转为全身麻醉。主要副作用是心动过缓（<100次/分钟）且无血氧饱和度下降，9例患者（1.8%）出现此情况。3例患者（0.62%）发生高位脊髓阻滞但无心动过缓和低血压。所有患者均未发生术后脑膜炎。
脊髓麻醉在接受下腹部、会阴和骨科手术的新生儿和婴儿中是安全有效的。为节省时间，我们建议在外科医生刷手后尝试脊髓麻醉，并尽量减少手术示教活动。无论麻醉类型如何，应对小且有时病情较重的患者需要有经验的儿科麻醉医生在场。
