SPINAL-ANESTHESIA FOR REPAIR OF MENINGOMYELOCELE IN NEONATES

The use of spinal anesthesia for meningomyelocele repair in neonates h as received minimal attention. Spinal anesthesia may lessen the stress response to surgery and decrease postoperative respiratory complicati ons. We therefore examined the efficacy of spinal anesthesia in 14 neo nates requiring repair of lumbar or sacral meningomyelocele. All neona tes were positioned prone with a small chest roll. Hyperbaric 0.5% tet racaine with epinephrine was injected into the caudal end of the menin gomyelocele sac. If necessary, supplemental tetracaine was administere d directly into the intrathecal space by the surgeon during the operat ion. Blood pressure, heart rate, and oxyhemoglobin saturation were mea sured throughout surgery. Neonates were monitored with transthoracic i mpedance apnea monitors, electrocardiogram (EGG), and pulse oximetry f or 36 h after surgery. Spinal anesthesia was successful in all cases. Seven patients received one supplemental tetracaine injection; one pat ient received two supplemental injections. Arterial blood pressure dec reased an average of 5 mm Hg with the largest decrease being 10 mm Hg. Two postoperative respiratory events occurred in the first 8 h after surgery. Both neonates had received intraoperative midazolam for sedat ion. Neurologic function was assessed pre- and postoperatively. Twelve patients had no change in neurologic function after surgery, while tw o infants demonstrated improved function. We conclude that spinal anes thesia can be safely used for meningomyelocele repair.