-
Curr Opin Anaesthesiol · Jun 2003
Awake spinal or caudal anaesthesia in preterms for herniotomies: what is the evidence based benefit compared with general anaesthesia?
- Andreas C Gerber and Markus Weiss.
- Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland. andreas.gerber@kispi.unizh.ch
- Curr Opin Anaesthesiol. 2003 Jun 1; 16 (3): 315-20.
Purpose Of ReviewPostoperative apnoea is known to threaten preterm and ex-preterm infants undergoing surgery for inguinal hernia. Awake regional anaesthesia, initially spinal and later caudal anaesthesia have been suggested as effective techniques to avoid these complications. However, most herniotomies in this group of patients are still performed under general anaesthesia without deleterious consequences. Whereas some experts continue to claim advantages for awake regional over general anaesthesia for preterm infants, others consider awake regional anaesthesia to be an exclusive, technically difficult and unreliable technique of unconfirmed benefit.Recent FindingsIt is appropriate to weigh the scarce available evidence that has been accumulated since 1984, and put it into perspective with new developments in paediatric general anaesthesia. The actual clinical significance of postoperative apnoea and improvements in neonatal and perioperative care and monitoring must also be reconsidered.SummaryThe available evidence does not allow unequivocal conclusions to be drawn or recommendations to be made. Awake regional anaesthesia for herniotomies in preterm infants has been found to be superior in most studies; however, it requires technical expertise and dedication on the part of the anaesthetist and surgeon. When light general anaesthesia with modern anaesthetic agents such as sevoflurane or desflurane is combined with a caudal block, postoperative apnoea is very rare, and can easily be recognized and managed with good postoperative monitoring and therapy.
Notes
Knowledge, pearl, summary or comment to share?You can also include formatting, links, images and footnotes in your notes
- Simple formatting can be added to notes, such as
*italics*
,_underline_
or**bold**
. - Superscript can be denoted by
<sup>text</sup>
and subscript<sub>text</sub>
. - Numbered or bulleted lists can be created using either numbered lines
1. 2. 3.
, hyphens-
or asterisks*
. - Links can be included with:
[my link to pubmed](http://pubmed.com)
- Images can be included with:
![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
- For footnotes use
[^1](This is a footnote.)
inline. - Or use an inline reference
[^1]
to refer to a longer footnote elseweher in the document[^1]: This is a long footnote.
.