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11–14 APRIL, 2018, HELSINKI, FINLAND
16:37–16:42
S12-2 (LO)
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SPINAL ANESTHESIA IN THE YOUNGEST OF PATIENTS:
NO NEED FOR ADVANCED AIRWAY MANAGEMENT
AND REDUCED NARCOTIC USAGE
Kristin EBERT
1
, Emmett WHITAKER
2
and Venkata JAYANTHI
1
1) Nationwide Children's Hospital, Section of Urology, Columbus, USA - 2) Nationwide Children's Hospital, Anesthesia,
Columbus, USA
PURPOSE
Concerns regarding potential negative effects of inhalataional and intravenous anesthetics on
neurocognitive development has led to a growing interest in alternative forms in infants. We report
on our institution’s outcomes with the use of spinal anesthesia (SA) for urological surgery in infants
less than 90 days of age, and compare their outcomes with a matched cohort of patients who
underwent general anesthesia (GA).
MATERIAL AND METHODS
Patients less than 90 days of age who underwent SA for four procedures (inguinal hernia repair,
scrotal exploration for torsion, PUV ablation, ureterocele puncture) were identified from our SA
database. An age- and procedure-matched control cohort was identified from a list of patients who
underwent the same procedures under GA. Outcomes recorded included success rate of spinal,
complications, narcotic and supplemental medication usage, airway management, need for sup-
plemental oxygen, and length of hospital stay.
RESULTS
Forty patients were identified; 20 in the SA group and 20 in the GA group. The mean age of the
entire cohort was 45.3 days. Eighty percent (16/20) of SA patients had successful SA without
conversion to GA; reasons for conversion included 3 with a failed lumbar puncture and 1 with
refractory agitation. All GA patients had endotracheal intubation, whereas none of the successful
SA patients needed any airway management. SA patients were significantly less likely to receive
narcotics during the operative procedure compared to the GA group (p=0.001), and also had a sig-
nificantly lower mean morphine equivalent dose/kilogram (p=0.002). Patients in the SA group were
also significantly less likely to receive any supplemental medications during the operative procedure
(p=0.001), particularly intravenous corticosteroids (p<0.001). There were no significant differences
in length of hospitalization between groups.
CONCLUSIONS
The use of SA in babies obviates the need for endotracheal tube placement and airway manage-
ment, and avoids the theoretic concerns regarding the effects of GAon neurocognitive development.