An alternative for avoidance of general anaesthesia for infants when bilateral inguinal herniorrhaphy outlasts subarachnoid blockade

• Published in: Pediatric anesthesia Vol. 10; no. 6; pp. 674 - 677
• Main Authors: CASSADY, JOSEPH F., LEDERHAAS, GEORGE
• Format: Journal Article
• Language: English
• Published: Oxford UK Blackwell Science Ltd 01.11.2000
• Subjects: apnoea; caudal; complications; prematurity; spinal
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/j.1460-9592.2000.00592.x

Former premature infants represent a high risk surgical population. In order to minimize the risk of postoperative apnoea, subarachnoid blockade without sedation is known to be preferable to general anaesthesia for former premature infants undergoing bilateral inguinal herniorrhaphy. However, subarachnoid blockade affords only a limited duration of reliable anaesthesia. Nonroutine surgical delays and technical difficulties cannot always be anticipated by the anaesthesiologist. When bilateral inguinal herniorrhaphy outlasts the anticipated duration of subarachnoid blockade, the anaesthesiologist is confronted with a dilemma. Infants are unable to complain verbally, so the extent of subarachnoid blockade may be difficult to assess intraoperatively. Introduction of sedation or general anaesthesia under these circumstances increases the risk of postoperative apnoea, thereby defeating the purpose of the original choice of anaesthesia. Several alternatives have been proposed, but all involve disadvantages. In this report of two cases, a new solution to this clinical dilemma is presented.