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Features of spinal anesthesia in children

PAEDIATRIC SURGERY.2016.3-4(52-53):90-95; doi 10.15574/PS.2016.52-53.90 

Features of spinal anesthesia in children 

Tkachenko I. S., Chadaev Y. M.

Mykolaiv Regional Children’s Hospital, Mykolaiv, Ukraine

Background: spinal anesthesia currently is one of the most leading method compared with other techniques of regional anesthesia in children. We achieve adequate analgesia carefully choosing puncture level and amount of the anesthetic, taking into consideration anatomical and physiological characteristics of children.

Objective: extending indications of spinal anesthesia in young children given their anatomical and physiological characteristics.

Materials and methods: in Mykolaiv Regional Children’s Hospital from 2011 to 2015 we performed spinal anesthesia in 1155 children, including 342 children younger 1 year of age. All children were assigned to groups on the basis of electiveness, location of surgery and age. The spinal anesthesia was performed using G-24 needle in neonates, G-23 needle in children from 1 month to 3 years and G-22 needle in older children. Lumbar puncture was performed in L4–L5 interspace before the lower abdominal, perineum or lower extremities surgeries, L3–L4 before the upper abdominal surgery in neonates, and L2–L3 before the upper abdominal surgery in children older 1 year of age.

Results. Neonates have narrow subarachnoid space containing about 20 cmі of cerebrospinal fluid. The volume of subarachnoid space is rapidly increasing to 30 cmі at 1 year, to 40–50 cmі at 5 years, and to 100–140 cmі at 8 years. It is necessary to take this into account choosing the size of the needle. Bevel of the needle should not exceed 2 mm. The volume of cerebrospinal fluid in neonates is up to 10 ml/kg of body weight, in children weighing less than 15 kg – 4 ml/kg, in adults – 2 ml/kg. This explains higher doses of local anesthetics in children. Lumbar lordosis is not well formed in children. This provides equal distribution of anesthetic in cranial and caudal directions from the site of the puncture, ensuring sensor block up to level Th7–Th8.

Conclusions: when selecting the type of anesthesia in children between total intravenous anesthesia and spinal anesthesia, spinal anesthesia has preference. In neonates subarachnoid space puncture was performed at level L3-L4 before the surgeries above the navel and at the level L4–L5 before the surgeries below the navel, using clearly perfect technique. Adequate anesthesia is achieved by bolus intrathecal injection of relatively high dose of Marcaine spinal heavy – 0.8–0.9 ml. The most frequently used local anesthetics are hyperbaric solutions. There is no necessity in mechanical ventilation during surgeries which are not accompanied by changes in intra-abdominal pressure. This method of anesthesia requires only minimal sedation. Selection of the needle plays an important role. In children older than 1-year subarachnoid space is punctured at level L2–L3 before the upper abdominal surgeries and at level L3–L4 before the lower abdominal surgeries. Adequate anesthesia is achieved by level of puncture. Injection of Marcaine spinal heavy 0.5% at a dose 0.3–0.5 mg/kg provides sensor blockage up to level Th7–Th10. There have been cases of arterial hypotension in children older than 5 years, which was corrected by infusion of fluids. Spinal anesthesia in children has many advantages: minimal requirements in narcotics, early recovery of consciousness, possibility of early enteral feeding to prevent postoperative ketonemia, particularly in children with neuro-arthritic constitution anomaly. Spinal anesthesia – feasible opportunity in one day surgery.

Key words: spinal anesthesia, children.


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