The following is the summary of “Spinal anesthesia in infants undergoing urologic surgery duration greater than 60 minutes” published in the December 2022 issue of Pediatric urology by Jefferson, et al.
Infants have been given Spinal anesthesia (SA) with no known adverse effects. However, data on the safety and effectiveness of SA in juvenile urologic procedures lasting ≥ 60 minutes are scant. To help parents prepare their infants for urologic procedures lasting less than an hour, researchers mapped out the preoperative period. To describe the nature and extent of SA’s safety and effectiveness during urologic procedures in newborns that last less than 60 minutes. From May 2018 through March 2021, we looked at data from a prospectively maintained database to see how many infants underwent SA for urologic operations lasting less than an hour. In addition to the lidocaine cream rubbed into the lumbar region before surgery, some patients were also given intranasal dexmedetomidine and intranasal fentanyl. The patient’s arms were swaddled, and oral sucrose was given on a pacifier as needed. Not needing to switch to general anesthesia was the success criterion. Dates and times were recorded for the beginning and ending of the spinal injection, the length of the procedure, the arrival and departure of the operating room (OR) wheels, and the patient’s release from the hospital.
During the study period, SA was used in 244 procedures; 76 infants (31% of the total) underwent operations lasting ≥ 60 minutes. A whopping seventy-three (96%) of them were finished with SA alone. 2 (67%) of the 3 patients who were switched to general anesthetic needed to switch to mask anesthesia after 96 and 169 minutes (for the last 10 minutes of operation), and one was switched to intubation before surgery even began. The average age of a patient was 6 months (interquartile range [IQR] 5-7 months), and the average length of the surgery was 95 minutes (IQR 75-120 minutes). At least one further dose of IV sedative was administered at a median time of 90 (IQR 60-120) minutes into surgery for 27 patients (36%) following initial preoperative intranasal dexmedetomidine ± fentanyl. Patients spent a median of 73 (IQR 61-96) minutes in recovery before being discharged following a surgery, leaving the operating room after a median of 10 (IQR 8-12) minutes.
In this article, researchers discuss using intrathecal bupivacaine delivered via a single injection in juvenile urological surgeries lasting less than an hour. The use of SA was described as safe in this report for newborns undergoing urologic procedures lasting at least 60 minutes, with roughly 40% of patients requiring extra IV dexmedetomidine and fentanyl. Swaddling the patient and giving them oral sugar were two non-pharmaceutical measures that helped a lot. The success of anesthesia relies on open lines of communication between the surgeon and the anesthesiologist during a case. Using spinal anesthetic with a single injection of bupivacaine is a safe and effective option for newborns undergoing urologic surgery that will take longer than an hour and up to three hours. The surgeon and the anesthesiologist should collaborate to determine which patients are good candidates for SA.
Source: sciencedirect.com/science/article/abs/pii/S1477513122003047
