Spinal Anesthesia in Pediatrics

*Enrique Hernández-Cortez, Yolanda M. Martínez-Barragán and Karen L. Iñiguez-Lopéz*

## **Abstract**

The survival of preterm newborn patients (PNB) depends in a great extent on the anesthetic technique used. Spinal anesthesia (SA) is considered the best-tolerated regional anesthetic method for highly unstable newborn infants (NB) with high risk of complications during the perioperative period. SA has been recommended for children at high risk for postoperative apnea due to general anesthetics or prematurity. Bronchopulmonary dysplasia (BPD) in the newborn is a disease that accompanies the patient to the operating room with a high incidence of mortality. SA in emergency surgery is a well-tolerated anesthetic procedure with proven effectiveness, with less hemodynamic and respiratory repercussions. At the same time, it produces greater protection against surgical stress in the NB weakened by the premature condition. Hemodynamic stability remains constant even in the newborn with heart disease.

**Keywords:** spinal anesthesia, regional anesthesia, newborn

### **1. Introduction**

The 8% of PNB require surgery to correct an organic birth defect in the first hours or days after birth. BPD in PNB is a serious disease with high mortality rates, which produces significant respiratory fragility with repercussions on the general condition of the patient. General anesthesia (GA) produces cardiovascular and hemodynamic changes that prolong intubation for hours or days after surgery, which complicates the underlying respiratory problem. Inhaled anesthetics, hypnotics, intravenous agents, and muscle relaxants can prolong and worsen the awakening of the NB.

In recent years, a large number of published articles have tried to demonstrate the existence of anesthetic agents that cause brain damage mainly in immature organs of preterm infants. The fundamental premise for the administration of anesthetics is their reversibility, which implies that the brain, spinal cord and peripheral nerves are anatomically and physiologically the same before and after the administration of any anesthetic agent. Therefore, the pediatric anesthesiologist faces the dilemma of which anesthetic agents cause less neurocognitive damage. An alternative to the problem of neurocognitive damage is spinal anesthesia, because local anesthetics (LA) produce a neuroprotective effect on the central nervous system, with minimal physiological changes [1].

The most frequent surgical procedures in the NB are inguinal hernia repair, duodenal atresia, pyloromyotomy, myelomeningocele repair, and imperforate anus repair. In most of these urgent surgical procedures, SA helps us to solve the surgical procedure with proven efficacy and safety. Hemodynamic stability remains constant even in PNB with heart disease, in non-cardiac surgery [2].
