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Spinal anesthesia in children: A review.

Gupta A, Saha U - J Anaesthesiol Clin Pharmacol (2014)

Bottom Line: To overcome this, several additives like epinephrine, clonidine, fentanyl, morphine, neostigmine etc. have been used and found to be effective even in neonates.Despite its widespread use, incidence of side-effects is low and permanent neurological sequalae have not been reported with SA.Literature yields encouraging results regarding its safety and efficacy.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, Delhi State Cancer Hospital, Dilshad Garden, New Delhi, India.

ABSTRACT
Even after a vast safety record, the role of spinal anesthesia (SA) as a primary anesthetic technique in children remains contentious and is mainly limited to specialized pediatric centers. It is usually practiced on moribund former preterm infants (<60 weeks post-conception) to reduce the incidence of post-operative apnea when compared to general anesthesia (GA). However, there is ample literature to suggest its safety and efficacy for suitable procedures in older children as well. SA in children has many advantages as in adults with an added advantage of minimal cardio-respiratory disturbance. Recently, several reports from animal studies have raised serious concerns regarding the harmful effects of GA on young developing brain. This may further increase the utility of SA in children as it provides all components of balanced anesthesia technique. Also, SA can be an economical option for countries with finite resources. Limited duration of surgical anesthesia in children is one of the major deterrents for its widespread use in them. To overcome this, several additives like epinephrine, clonidine, fentanyl, morphine, neostigmine etc. have been used and found to be effective even in neonates. But, the developing spinal cord may also be vulnerable to drug-related toxicity, though this has not been systematically evaluated in children. So, adjuvants and drugs with widest therapeutic index should be preferred in children. Despite its widespread use, incidence of side-effects is low and permanent neurological sequalae have not been reported with SA. Literature yields encouraging results regarding its safety and efficacy. Technical skills and constant vigilance of experienced anesthesia providers is indispensable to achieve good results with this technique.

No MeSH data available.


Related in: MedlinePlus

Anatomical landmarks for pediatric spinal
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Figure 2: Anatomical landmarks for pediatric spinal

Mentions: Dural Sac: Terminates at S3 and spinal cord at L3 vertebral levels, at birth. Adult level (S2 and L1 respectively) is not reached until 2nd year of life [Figure 1]. Thus, it is prudent to use a low approach (L4-5 or L5-S1) to avoid damage to spinal cord[16] [Figures 2 and 3]. Intercristal line (Tuffier's line) still remains a reliable landmark similar to adults since in younger children, it passes through L4-5 /L5 –S1. Newborns have a narrow subarachnoid space (6-8 mm) and low CSF pressure, necessitating greater precision and avoidance of lateral deviation.


Spinal anesthesia in children: A review.

Gupta A, Saha U - J Anaesthesiol Clin Pharmacol (2014)

Anatomical landmarks for pediatric spinal
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927267&req=5

Figure 2: Anatomical landmarks for pediatric spinal
Mentions: Dural Sac: Terminates at S3 and spinal cord at L3 vertebral levels, at birth. Adult level (S2 and L1 respectively) is not reached until 2nd year of life [Figure 1]. Thus, it is prudent to use a low approach (L4-5 or L5-S1) to avoid damage to spinal cord[16] [Figures 2 and 3]. Intercristal line (Tuffier's line) still remains a reliable landmark similar to adults since in younger children, it passes through L4-5 /L5 –S1. Newborns have a narrow subarachnoid space (6-8 mm) and low CSF pressure, necessitating greater precision and avoidance of lateral deviation.

Bottom Line: To overcome this, several additives like epinephrine, clonidine, fentanyl, morphine, neostigmine etc. have been used and found to be effective even in neonates.Despite its widespread use, incidence of side-effects is low and permanent neurological sequalae have not been reported with SA.Literature yields encouraging results regarding its safety and efficacy.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, Delhi State Cancer Hospital, Dilshad Garden, New Delhi, India.

ABSTRACT
Even after a vast safety record, the role of spinal anesthesia (SA) as a primary anesthetic technique in children remains contentious and is mainly limited to specialized pediatric centers. It is usually practiced on moribund former preterm infants (<60 weeks post-conception) to reduce the incidence of post-operative apnea when compared to general anesthesia (GA). However, there is ample literature to suggest its safety and efficacy for suitable procedures in older children as well. SA in children has many advantages as in adults with an added advantage of minimal cardio-respiratory disturbance. Recently, several reports from animal studies have raised serious concerns regarding the harmful effects of GA on young developing brain. This may further increase the utility of SA in children as it provides all components of balanced anesthesia technique. Also, SA can be an economical option for countries with finite resources. Limited duration of surgical anesthesia in children is one of the major deterrents for its widespread use in them. To overcome this, several additives like epinephrine, clonidine, fentanyl, morphine, neostigmine etc. have been used and found to be effective even in neonates. But, the developing spinal cord may also be vulnerable to drug-related toxicity, though this has not been systematically evaluated in children. So, adjuvants and drugs with widest therapeutic index should be preferred in children. Despite its widespread use, incidence of side-effects is low and permanent neurological sequalae have not been reported with SA. Literature yields encouraging results regarding its safety and efficacy. Technical skills and constant vigilance of experienced anesthesia providers is indispensable to achieve good results with this technique.

No MeSH data available.


Related in: MedlinePlus