Abstract
To avoid the high incidence of respiratory complications associated with general anaesthesia in premature neonates, 44 spinal anaesthetics for inguinal hernia repair in very low birthweight infants were administered in 47 attempts. Hyperbaric tetracaine with epinephrine 1:200,000 was administered in a dose range of 0.27–1.10 μg · kg−1. Attempted lumbar puncture failed in three infants. In 24 procedures, spinal anaesthesia alone provided satisfactory operating conditions; in 20, supplementary inhalational general anaesthesia or iv ketamine was necessary. Perioperative apnoeic episodes requiring bag/mask assisted ventilation occurred in six infants. In five infants, apnoeic spells occurred in the postoperative period. No infant required tracheal intubation; there was no haemodynamic instability. Twenty-four infants required no postoperative analgesia. Our experience suggests that spinal anaesthesia for inguinal hernia repair in very low birth weight infants reduces but does not eliminate the risk of respiratory instability, and that supplementary anaesthesia is often necessary to provide satisfactory operating conditions.
Résumé
Dans le but d’échapper aux complications respiratoires de l’anesthésie générale, nous avons réussi 44 rachidiennes en 47 essais pour fin d’herniotomie inguinale chez de grands prématurés en employant de 0,27 àa 1,10 μg · kg−1 de tetracaine hyperbare avec adrénaline 1:200000. Nos tentatives de ponction lombaire onl échoue trois fois. Chez 24 enfants, Ianesthésie rachidienne s’avéra suffisante mais chez 20 autres, on dut lui ajouter des anesthesiques en inhalation ou de la kétamine iv. Des épisodes d’apnée survinrent en période péri-opératoire chez six des enfants ayant reçu des anesthesiques en inhalation. En tout, cinq enfants eurent des épisodes d’apnée en période postopératoire mais aucun n’eut besoin d’une intubation trachéale. Les variables hémodynamiques furent toujours stables. Vingt-quatre enfants n’eurent besoin d’aucun analgésique en période postopératoire. Bref, l’anesthésie rachidienne pour herniotomie inguinale chez les prématurés de très petit poids nélimine pas tous les risques de complication respiratoire et ne suffit souvent pas à produire une anesthésie chirurgicale.
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Webster, A.C., McKishnie, J.D., Kenyon, C.F. et al. Spinal anaesthesia for inguinal hernia repair in high-risk neonates. Can J Anaesth 38, 281–286 (1991). https://doi.org/10.1007/BF03007615
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DOI: https://doi.org/10.1007/BF03007615