Awake spinal anaesthesia in ex-premature infants

摘要: Advances in medicine can emerge from the demonstration of a radical improvement outcome that sets new standard practice. Brawn presented his data on surgical technique resulted excellent early palliation 15 24 consecutive patients with hypoplastic left heart syndrome, condition which until recently was regarded as fatal. In other areas, advances treatment are seemingly so clear and practical they become adopted advance complex trials. The rapid deployment inhaled nitric oxide neonatal intensive care for conditions associated raised puhnonary vascular resistance falls into this category. By contrast, reports by Cot~ documenting fragility ventilatory drive ex-premature infant studies Krane Oberlander showing apparent advantages awake spinal anaesthesia over general herniorraphy group, have not led to universal acceptance technique. Superficially, argument afferentnerve block is strong has been used imply failure use techniques constitutes care. However, closer examination far clear, emergence 1995 desflurane sevoflurane, anaesthetic agents striking recovery characteristics infants, may offer more solutions 1996. presenting inguinal hernia repair significant risk life-threatening apnoea after surgery, but assessment factors difficult. Cot6 combined analysis original eight prospective confirm postoperative inversely related age, at least 5% 48 weeks postconceptual age gestational 35 weeks. Preoperative monitoring reveals multiple episodes disturbance, shown that, whilst does seem worsen condition, halothane does. rate 10-20% reported sole group questionable. Awake always popular surgeons: surgery becomes difficult if incomplete, additional sedation or negates potential benefits (Anesthesiology 1990; 72: 838). A spinal/epidural method improves reliability extends duration block, allowing less rushed approach (Pediatric Anaesth 1994; 4: 221), oral sucrose, reduces behavioural responses pain, Haouari, be administered without pacifier improve surgeon (figure). Nevertheless, widely many paediatric centres quietly tried rejected it.