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PEDIATRIC ANESTHESIA

Spinal Anesthesia with Bupivacaine Decreases Cerebral Blood Flow in Former Preterm Infants

From the Département d’Anesthésie Réanimation, Centre Hospitalo-Universitaire de Bicêtre, Kremlin Bicêtre, France

Address correspondence and reprint requests to Dan Benhamou, MD, Department of Anesthesiology and Intensive Care Medicine, CHU de Bicêtre 78, Rue du Général Leclerc F-94275 Kremlin Bicêtre. Address email to mariepierre.bonnet{at}9online.fr

Spinal anesthesia is commonly used in former preterm infants (FPI). In these patients, hypotension induced by spinal anesthesia may impair cerebral blood flow. We measured cerebral blood flow velocity (CBFV) by transcranial Doppler ultrasound to assess the effect of hypotension induced by spinal anesthesia on cerebral hemodynamics. Twelve FPI scheduled for inguinal hernia repair were operated under spinal anesthesia using 1 mg/kg isobaric 0.5% bupivacaine. Systolic, diastolic, and mean middle cerebral artery CBFV were measured at 5 min before and 5 min and 10 min after spinal anesthesia using a transcranial pulsed Doppler ultrasonography. Arterial blood pressure and heart rate were recorded simultaneously. Cerebral arteries resistance index (RI) was calculated as RI = (peak systolic CBFV – end-diastolic CBFV)/peak systolic CBFV. Diastolic CBFV decreased significantly from 30.0 ± 11.1 cm/s to 20.1 ± 8.4 cm/s at 5 min and to 20.1 ± 7.0 cm/s at 10 min. RI increased significantly from 0.7 ± 0.1 to 0.8 ± 0.1 at 5 min and 10 min. Systolic, diastolic, and mean arterial blood pressures decreased significantly at the same time intervals. We suggest that in FPI, spinal anesthesia induces a decrease in cerebral blood flow related to changes in arterial blood pressure. Whether these changes have deleterious consequences remains to be determined.

IMPLICATIONS: In former preterm infants having spinal anesthesia with bupivacaine, a decrease in cerebral blood flow velocity is displayed by middle cerebral artery transcranial Doppler examination.

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