Caudal epidural anesthesia in conscious premature and high-risk infants.

Twenty premature or high-risk infants received caudal epidural anesthesia for inguinal herniorrhaphy, orchiopexy, and circumcision. Mean gestational age at surgery was 48 +/- 12 weeks; mean weight at surgery was 4,100 +/- 1,400 g. Caudal anesthesia, performed with 1 mL/kg of 0.375% bupivacaine, was successful in 19 of 20 infants. Onset of anesthesia occurred in 14 +/- 1 minutes; duration of surgical anesthesia was 89 +/- 8 minutes. Surgical conditions were generally excellent and the infants tolerated anesthesia and surgery well. No postoperative complications were observed. Caudal epidural anesthesia is an acceptable alternative to general or spinal anesthesia in premature and high-risk infants.