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Is spinal anaesthesia in young infants really safer and better than general anaesthesia?

Disma, Nicola; Clunies-Ross, Natasha; Chalkiadis, George A.
Curr Opin Anaesthesiol; 31(3): 302-307, 2018 Jun.
Artigo em Inglês | MEDLINE | Fev 2018 | ID: mdl-29432293
Resumo: PURPOSE OF REVIEW: Concerns regarding the potential neurotoxic effects of general anaesthesia have seen resurgence in awake spinal anaesthesia in neonates and infants. This review includes recently published data from a large prospective randomized controlled trial with view to determining if spinal anaesthesia is safer and better than general anaesthesia in this population. RECENT FINDINGS: Compared with general anaesthesia, spinal anaesthesia results in less haemodynamic instability and fewer early (<30 min) apnoeic episodes in neonates and infants undergoing inguinal herniorraphy; the overall incidence of apnoeas in the first 12 h postoperatively was similar. Neurodevelopmental outcome 2 years postoperatively was similar. An appreciable failure rate for spinal anaesthesia was confirmed. SUMMARY: Spinal anaesthesia represents a suitable alternative to general anaesthesia in neonates and infants undergoing minor surgery avoiding the need for endotracheal intubation and ventilation. Spinal anaesthesia has some advantages but a significant failure rat and has not been demonstrated to improve neurodevelopmental outcome.