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Spinal Anesthesia a Successful Alternative to General Anesthesia

Customizable, low-risk technique shows several benefits in a wide range of urology procedures

As research continues to illuminate the possibility pediatric patients suffer neurotoxic effects from general anesthesia, surgeons and anesthesiologists at Nationwide Children’s Hospital have already sought an alternative: spinal anesthesia. Their methods, used on children 2 years of age and younger, boast a high success rate, reduced need for systemic sedatives and a more efficient operating process from preparation to recovery.

Spinal anesthesia has proven viable and low-risk in a wide range of pediatric urology procedures, Nationwide Children’s Rama Jayanthi, MD, chief of the Section of Urology, Emmett Whitaker, MD, attending anesthesiologist, and colleagues report in the Journal of Pediatric Urology.

“Anything below the abdomen could be considered for spinal anesthesia.”

– Rama Jayanthi, MD

Out of 105 urology procedures using spinal anesthesia (on children ages 19 days to 24 months), overall success was 84 percent, including placement and no need to convert to general anesthesia. Among 75 of the 88 children who had a successful lumbar puncture, no additional sedation was required.The technique offers motor and sensory block coverage for 90 minutes or more by using a customized combination of bupivacaine, epinephrine and clonidine. Drs. Whitaker and Jayanthi are optimistic this option could allow many patients to completely avoid potential neurotoxic effects.

“Spinal anesthesia also reduces time to the reunion with parents,” Dr. Jayanthi says. “Once the surgery is complete, children are back in their parents’ arms within 10 or 15 minutes.”

Children can bypass the post-anesthesia care unit (PACU) and go directly to phase II/step-down care.

“Pain control is excellent, and anecdotally, parent satisfaction is high,” Dr. Whitaker says. “Many high-risk elements of general anesthesia in small children can be avoided. The data also support an improvement in operating room efficiency as well as reduced postoperative pain scores, faster recovery times and far less need for airway management or supplemental oxygen.”

According to Dr. Jayanthi, procedures amenable to spinal anesthesia include:

  • Circumcisions/revisions
  • Inguinal hernia/hydrocele
  • Orchidopexy
  • Neonatal torsion
  • Cytoscopic procedures
  • Hypospadias
  • Nonpalpable (intra-abdominal) testis
  • Ureterostomy
  • Ureteral reimplantation
  • Vesicostomy

“Anything below the abdomen could be considered for spinal anesthesia,” he says. Additional possibilities include use in the MRI suite and orthopedics.

The doctors attribute their success to planning and partnership.

“We prepared for a year before we did our first spinals. We talked to everybody,” Dr. Whitaker says.

The team developed a protocol, created a custom spinal anesthesia kit and discussed the procedures with all key stakeholders, from post-operative nursing assistants to the entire surgical and anesthesiology teams, including fellows.

Whitaker EE, Wiemann BZ, DaJusta DG, Alpert SA, Ching CB, McLeod DJ, Tobias JD, Jayanthi VR. Spinal anesthesia for pediatric urological surgery: Reducing the theoretic neurotoxic effects of general anesthesia. Journal of Pediatric Urology. 2017 Jul 14. [Epub ahead of print]

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