Implementation of a spinal anesthesia protocol to repair inguinal hernia in extremely preterm breastfed babies

Experience conducted at the Pereira Rossel Hospital Center

Abstract

Introduction: spinal anesthesia is associated to a lower incidence of respiratory complications and a faster recovery when compared to general anesthesia in extremely preterm breastfed babies (younger than 37 weeks) who undergo an inguinal hernia repair surgery before week 60.
Objectives: the study aims to present the experience when a protocol was implemented in 15 children who met these criteria.
Method: the patients did not evidence comorbility factors, the preoperative paraclinical studies were normal and the peripheral oxygen saturation (SpO2) on room air was between 98% and 99%. Puncture was done with 2.5 cm long 25G Quincke needle on a sitting down position. The patient was given 0.5 cc of hyperbaric bupivacaine, 0.5%.
Results: the technique was successful in 11 cases, in three out of the four failures the subarachnoid space could not be accessed and in one patient the anesthetic time was not enough to complete the surgery and additional sedation was needed. Average number of attempts was 1.6 ± 0,9 with 66.7% in the first case (n = 15); motor anesthetic latency 56.7 ± 13.5 sec (n = 12). For an average length of surgery of 46.2 ± 14.8 min, anesthesia lasted 63.2 ± 8.2 min, achieving adequate surgical conditions to complete the procedure in 11 patients. There were no significant hemodynamic or respiratory modifications, except for the paradoxical breathing with no arterial desaturation in two cases. Regular feeding was reinitiated in the anesthesia recovery room along with the mother, and they stayed 24 hours hospitalized without evidencing complications.
Conclusions: the evaluation of the application of this protocol for spinal anesthesia showed it is a safe and effective technique with a fast recovery for this group of patients.