Pediatric Spinal Anesthesia Combined with General Anesthesia

Abstract

  Every anesthesiologist should have the expertise to perform spinal anesthesia. Although pediatric spinal anesthesia is an easy and effective technique, it is not popular in Japan. Spinal anesthesia provides highly effective anesthesia, analgesia, and sympathetic and motor blocks in the lower body. Spinal anesthesia may cause the same adverse effects in children as have been reported in adults. In children, higher doses of local anesthetics are required, and they are associated with a shorter duration of action and increased hemodynamic stability compared to adults even with high blocks. The benefits of pediatric spinal anesthesia are most evident in pediatric day-case surgery. In our institution, spinal anesthesia is mostly used for laparoscopic percutaneous extraperitoneal closure.
  The puncture must be performed at the L4-L5 or L5-S1 spaces to prevent spinal injuries. It is important to understand the anatomy of the spinal canal when spinal anesthesia is induced. Recently, ultrasound imaging has been used more frequently to measure the depth of the subarachnoid space and locate the conus medullaris. Patients should be selected carefully, assessing the risks and benefits of pediatric spinal anesthesia in each individual case.