Clinical report on spinal anaesthesia in infants and children for orthopaedic surgery: 10 years' experience

Over a period of 10 years various orthopaedic-paediatric operations were performed under hyperbaric spinal anaesthsia. Methods. The children were randomly assigned to five groups: I, 0-6 months; II, 6-12 months; III, 1-5 years; IV, 5-10 years; V, 10-15 years. The children fasted for at least 4-6 h prior to surgery and were premedicated with midazolam. Spinal anaesthesia was achieved with hyperbaric (8% glucose) bupivacaine 0.5% at a dose of 0.5-1.0 mg/kg. After the monitors were attached, the patient was placed in the lateral decubitus position with chin extended. The lumbar spine was punctured in the lowest, most easily palpable interspace below the third lumbar vertebra using a 25-, 29-gauge, 9-cm disposable spinal needle. The local anaesthetic was injected over a period of 15-30 s. Ketamine 1 mg/kg was administered intravenously if the child was restless. The spread of blockade was tested by means of pin pricks and motor blockade with a Bromage schema. All patients were monitored electrocardiographically. If necessary a transcutaneous pO(2) monitor was used to avoid high arterial oxygen tension. The spinal anaesthesia was considered to be completely successful if the child was assessed as free of pain during the surgical procedure and if no supplementary agents were used. Midazolam was necessary for sedation. Results. The children ranged in age from 6 weeks to 15 years. Haemodynamic pattern and respiration were stable during spinal anaesthesia. The intra- and postoperative condition of circulation and analgesia were very good, also without complications. The only intraoperative complication was hypotension in groups IV and V. Conclusions. The duration of spinal anaesthesia in infants is shorter than in adult patients. Spinal anaesthesia is a suitable anaesthetic technique for paediatric surgery. This method of anaesthesia may avoid the increased incidence of postoperative respiratory complications associated with general anaesthesia. Special anatomical and pharmacological considerations for infants under 1 year of age include the fact that the spinal cord may end as low as L3 in the neonate. Our results show that spinal anaesthesia can be safely and reliably performed in these infants. Hyperbaric bupivacaine 0.5% as a spinal anaesthetic agent in infants has been investigated extensively and produces consistently good operating conditions. The technique has not resulted in hypotension or bradycardia, and no complications have occurred. We did not use at atropine in any patient. However, the superiority of spinal anaesthesia over other forms of anaesthesia in this group of patients remains to be demonstrated. Continuous training and critical analysis are needed for good results.