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PEDIATRIC ANESTHESIA

The Safety and Efficacy of Spinal Anesthesia for Surgery in Infants: The Vermont Infant Spinal Registry

Robert K. Williams, MD^*, David C. Adams, MD^*, Eva V. Aladjem, MD^*, Joseph M. Kreutz, MD^*, Kennith H. Sartorelli, MD, Dennis W. Vane, MD, and J. Christian Abajian, MD^*

Departments of *Anesthesia, Pediatrics, and Surgery, University of Vermont, College of Medicine and Vermont Children’s Hospital, Burlington, Vermont

Address correspondence and reprint requests to Robert K. Williams, MD, Department of Anesthesia, University of Vermont, College of Medicine, Burlington, VT 05405. Address e-mail to robert.williams{at}vtmednet.org.

Studies with modest numbers of patients have suggested that spinal anesthesia in infants is associated with a very infrequent incidence of complications, such as hypoxemia, bradycardia, and postoperative apnea. Although spinal anesthesia would seem to be a logical alternative to general anesthesia for many surgical procedures, it remains an underutilized technique. Since 1978, clinical data concerning all infants undergoing spinal anesthesia at the University of Vermont have been prospectively recorded. In all, 1554 patients have been studied. Anesthesia was performed by anesthesia trainees and attending anesthesiologists. The success rate for LP was 97.4%. An adequate level of spinal anesthesia was achieved in 95.4% of cases. The average time required to induce spinal anesthesia was 10 min. Oxygen hemoglobin desaturation to <90% was observed in 10 patients. Bradycardia (heart rate <100 bpm) occurred in 24 patients (1.6%). This study confirms the infrequent incidence of complications associated with spinal anesthesia in infants. Spinal anesthesia can be performed safely, efficiently, and with the expectation of a high degree of success. Spinal anesthesia should be strongly considered as an alternative to general anesthesia for lower abdominal and lower extremity surgery in infants.

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