Evaluation of caudal anaesthesia performed in conscious ex-premature infants for inguinal herniotomies

Ex-premature infants, before 45 weeks postconceptional age, are at high-ris k of apnoea after surgery. General anaesthesia increases the risk of apnoea . We evaluated the tolerance and the efficiency of caudal anaesthesia perfo rmed in 25 consecutive conscious ex-premature infants for inguinal hernioto mies. N2O/O-2 and EMLA cream are used to facilitate caudal puncture. Anaest hesia procedure, patient comfort and complications following the 24 postope rative hours were studied. We report good anaesthesia conditions without co mpromising the baby's comfort and few perioperative complications. Only two infants with a prior history of apnoea or bronchopulmonary dysplasia had a pnoea during and after surgery. A total spinal anaesthesia was the major co mplication in one infant and prolonged surgery requiring general anaesthesi a was the main limitation of this technique in another child. The principal advantage of the procedure is to facilitate and simplify the postoperative management of the babies. The anaesthetic technique does not alter surgica l conditions. Caudal epidural anaesthesia performed in awake high-risk pret erm infants is beneficial for these infants but requires experienced operat ors.