Anestesia subaracnóidea em crianças

Abstract

Background and Objectives - Pediatric spinal anesthesia has gained popularity mainly as an alternative to general anesthesia in pre-term neonates at risk for developing neonatal apnea. This study aimed at evaluating anatomic, physiologic and pharmacological differences of the technique in children. Contents - Spinal anesthesia in children is being used since the early 20th century, but was overlooked for many years due to the introduction of inhalational anesthetics and neuromuscular blockers. It regained popularity in 1979. Its positive effects in pediatric anesthesia are cardiovascular stability in children up to 8 years of age, satisfactory analgesia and muscle relaxation. Most popular pediatric anesthetics are tetracaine and bupivacaine in doses adjusted to body weight, but this technique is limited by a relatively short duration of anesthesia. Surgical procedures cannot last more than 90 min and there is no satisfactory postoperative pain control. Complications are the same for adult patients and include post-dural puncture headache and transient radicular irritation. Indications are: lower abdomen, genitalia, perineal region, lower limbs and in some cases, even thoracic surgeries. It is particularly attractive for pre-term neonates at higher risk for postoperative apnea after general anesthesia. Conclusions - Spinal anesthesia in children is a relatively safe technique with few complications and may be considered an alternative for general anesthesia, especially for pre-term neonates at risk for postoperative respiratory complications.