SPINAL-ANESTHESIA FOR PRIMARY REPAIR OF GASTROSCHISIS - A NEW AND SAFE TECHNIQUE FOR SELECTED PATIENTS

Spinal anesthesia has been described for infants and premature babies undergoing minor operative procedures. The advantages of shorter opera ting time, avoidance of intubation, and shorter hospital stay have mad e this the gold standard for premature and other high-risk infants req uiring minor procedures. However, little is known about this technique for major interventions in newborns and preterm infants. Recently, fo ur infants born with gastroschisis underwent repair under spinal anest hesia. Two had accompanying intestinal atresia (one with a prenatal pe rforation and pan-hypopituitarism), and two had intact gastrointestina l systems. The gestational ages were 39, 33, 36, and 36 weeks, respect ively. All had primary closure of the defect; one had no repair of the atresia because the bowel was thick and matted with a significant pee l, and the defect was not identified. In the second case with atresia, necrosis and perforation of a localized segment of intestine was iden tified proximal to the intestinal atresia, and was exteriorized with t he primary repair. When they arrived in the operating room, all four i nfants were breathing spontaneously, on room air, after appropriate fl uid resuscitation. All underwent spinal anesthesia, which was the only agent used for the operation. The operative time was 45, 25, 30, and 25 minutes, respectively (mean, 31.25 minutes). The duration of anesth esia was 170 to 230 minutes (mean. 205 minutes). All infants were retu rned to the neonatal intensive care unit on room air and breathing spo ntaneously. One was given morphine postoperatively and suffered signif icant respiratory depression, requiring intubation. It appears that sp inal anesthesia is safe and effective for major operative procedures i n high-risk infants. This mechanism often alleviates the need for intu bation and the concomitant risks for premature babies undergoing opera tion who demonstrate no need for assisted ventilation preoperatively. Given the proven efficacy and safety of this technique, modern neonata l care obligates the consideration of spinal anesthesia for major and minor operative procedures in selected patients. Copyright (C) 1994 by W.B. Saunders Company