ORIGINAL ARTICLE

Hemodynamic changes during spinal anesthesia in premature infants with congenital heart disease undergoing inguinal hernia correction

Ze’ev Shenkman

Department of Anesthesia, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Victor M. Johnson,

Victor M. Johnson

Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, and Harvard Medical School, Boston, MA, USA

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David Zurakowski,

David Zurakowski

Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, and Harvard Medical School, Boston, MA, USA

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Shmuel Arnon,

Shmuel Arnon

Department of Neonatology, Meir Medical Center, Kfar Saba and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Navil F. Sethna,

Navil F. Sethna

Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, and Harvard Medical School, Boston, MA, USA

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Ze’ev Shenkman,

Ze’ev Shenkman

Department of Anesthesia, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Victor M. Johnson,

Victor M. Johnson

Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, and Harvard Medical School, Boston, MA, USA

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David Zurakowski,

David Zurakowski

Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, and Harvard Medical School, Boston, MA, USA

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Shmuel Arnon,

Shmuel Arnon

Department of Neonatology, Meir Medical Center, Kfar Saba and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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Navil F. Sethna,

Navil F. Sethna

Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, and Harvard Medical School, Boston, MA, USA

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First published: 15 May 2012

https://doi.org/10.1111/j.1460-9592.2012.03873.x

Citations: 20

Navil F. Sethna, Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, and Harvard Medical School, Boston, MA, USA
Email: [email protected]

Section Editor: Adrian Bosenberg

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Summary

Introduction: There are conflicting reports on the effects of spinal anesthesia (SA) on hemodynamics. Data on the hemodynamic effects of SA in infants with congenital heart disease (CHD) are limited.

Methods: We reviewed our experience with 44 unsupplemented SA with 1 mg·kg⁻¹ of either hyperbaric tetracaine or bupivacaine in premature and former premature infants with noncyanotic CHD. Hemodynamics and oxyhemoglobin saturation (SpO₂) were assessed. Neither preoperative fluid boluses nor atropine was administered to any of the infants.

Results: There was no significant change in systolic, diastolic, or mean blood pressures from pre-SA induction compared with end of surgery. Heart rate showed a small but systematic decline (mean change of 10 beats per minute, P < 0.01) but was within the normative range values for age. There was a small, but clinically insignificant increase in SpO₂ across the time course. Intraoperatively, two infants developed transient apneic spells. No infant developed postoperative apnea, oxygen desaturation, or bradycardia.

Conclusions: The data suggest that SA with 1 mg·kg⁻¹ of either hyperbaric tetracaine or bupivacaine can be used safely as the sole anesthetic for inguinal hernia repair in infants with noncyanotic CHD even when fluid restricted and apparently causes minimal respiratory complications in these infants.

References

1 Welborn LG, Rice LJ, Hannallah RS et al. Postoperative apnea in former preterm infants: prospective comparison of spinal and general anesthesia. Anesthesiology 1990; 72: 838–842.
10.1097/00000542-199005000-00012
CAS PubMed Web of Science® Google Scholar
2 William JM, Stoddart PA, Williams SA et al. Post-operative recovery after inguinal herniotomy in ex-premature infants: comparison between sevoflurane and spinal anaesthesia. Brit J Anaesth 2001; 86: 366–371.
10.1093/bja/86.3.366
PubMed Web of Science® Google Scholar
3 Williams RK, Adams DC, Aladjem EV et al. The safety and efficacy of spinal anesthesia for surgery in infants: the Vermont Infant Spinal Registry. Anesth Analg 2006; 102: 67–71.
10.1213/01.ANE.0000159162.86033.21
PubMed Web of Science® Google Scholar
4 Krane EJ, Haberkern CM, Jacobson LE. Postoperative apnea, bradycardia, and oxygen desaturation in formerly premature infants: prospective comparison of spinal and general anesthesia. Anesth Analg 1995; 80: 7–13.
CAS PubMed Web of Science® Google Scholar
5 Cote CJ, Zaslavsky A, Downes JJ et al. Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis. Anesthesiology 1995; 82: 809–822.
10.1097/00000542-199504000-00002
CAS PubMed Web of Science® Google Scholar
6 Bonnet MP, Larousse E, Asehnoune K et al. Spinal anesthesia with bupivacaine decreases cerebral blood flow in former preterm infants. Anesth Analg 2004; 98: 1280–1283.
10.1213/01.ANE.0000108962.37210.69
PubMed Web of Science® Google Scholar
7 Dohi S, Naito H, Takahashi T. Age-related changes in blood pressure and duration of motor block in spinal anesthesia. Anesthesiology 1979; 50: 319–323.
10.1097/00000542-197904000-00007
CAS PubMed Web of Science® Google Scholar
8 Mahe V, Ecoffey C. Spinal anesthesia with isobaric bupivacaine in infants. Anesthesiology 1988; 68: 601–603.
10.1097/00000542-198804000-00020
CAS PubMed Web of Science® Google Scholar
9 Oberlander TF, Berde CB, Lam KH et al. Infants tolerate spinal anesthesia with minimal overall autonomic changes: analysis of heart rate variability in former premature infants undergoing hernia repair. Anesth Analg 1995; 80: 20–27.
CAS PubMed Web of Science® Google Scholar
10 Katznelson R, Mishaly D, Hegesh T et al. Spinal anesthesia for diagnostic cardiac catheterization in high-risk infants. Pediatr Anesth 2005; 15: 50–53.
10.1111/j.1460-9592.2004.01393.x
CAS PubMed Web of Science® Google Scholar
11 Muller KE, Barton CN. Approximate power for repeated measures anova lacking sphericity. J Am Stat Assoc 1989; 84: 5449–5455.
Google Scholar
12 Crowder MJ, Hand DJ. Analysis of Repeated Measures. NY: Chapman and Hall Publishing, 1990.
Google Scholar
13 Shenkman Z, Hoppenstein D, Litmanowitz I et al. Spinal anesthesia in 62 premature, former-premature or young infants--technical aspects and pitfalls. CJA 2002; 49: 262–269.
PubMed Web of Science® Google Scholar
14 Gemelli M, Manganaro R, Mami C et al. Longitudinal study of blood pressure during the 1st year of life. Eur J Pediatr 1990; 149: 318–320.
10.1007/BF02171556
CAS PubMed Web of Science® Google Scholar
15 Fleming S, Thompson M, Stevens R et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 2011; 377: 1011–1018.
10.1016/S0140-6736(10)62226-X
PubMed Web of Science® Google Scholar
16 Zubrow AB, Hulman S, Kushner H et al. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol 1995; 15: 470–479.
CAS PubMed Google Scholar
17 Pejovic B, Peco-Antic A, Marinkovic-Eric J. Blood pressure in non-critically ill preterm and full-term neonates. Pediatr Nephrol 2007; 22: 249–257.
10.1007/s00467-006-0311-3
PubMed Web of Science® Google Scholar
18 Williams RK, Abajian JC. High spinal anaesthesia for repair of patent ductus arteriosus in neonates. Paediatr Anaesth 1997; 7: 205–209.
10.1046/j.1460-9592.1997.d01-70.x
CAS PubMed Web of Science® Google Scholar
19 Kent AL, Kecskes Z, Shadbolt B et al. Blood pressure in the first year of life in healthy infants born at term. Pediatr Nephrol 2007; 22: 1743–1749.
10.1007/s00467-007-0561-8
PubMed Web of Science® Google Scholar
20 Schachter J, Kuller LH, Perfetti C. Blood pressure during the first two years of life. Am J Epidemiol 1982; 116: 29–41.
CAS PubMed Web of Science® Google Scholar
21 Bahlmann F, Reinhard I, Krummenauer F et al. Blood flow velocity waveforms of the fetal middle cerebral artery in a normal population: reference values from 18 weeks to 42 weeks of gestation. J Perinat Med 2002; 30: 490–501.
10.1515/JPM.2002.077
PubMed Web of Science® Google Scholar
22 Crapanzano MS, Strong WB, Newman IR et al. Calf blood pressure: clinical implications and correlations with arm blood pressure in infants and young children. Pediatrics 1996; 97: 220–224.
CAS PubMed Web of Science® Google Scholar

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Volume22, Issue9

September 2012

Pages 865-870

Hemodynamic changes during spinal anesthesia in premature infants with congenital heart disease undergoing inguinal hernia correction

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Hemodynamic changes during spinal anesthesia in premature infants with congenital heart disease undergoing inguinal hernia correction

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