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Real time ultrasound-guided spinal anesthesia in infants - a recent single-center experience.

Emília Francisco1, Rita Regufe2, Joana Figueiredo3, Hugo Trindade3, José Luís Ferreira3

1 - Anestesia, Centro Hospitalar Tondela Viseu, Viseu.
2 - Anestesia, Centro Hospitalar de Setúbal, Setúbal.
3 - Anestesia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa.

- Comunicação em congresso internacional – 36th Anual ESRA 2017, Lugano, Suiça (13-16 de Setembro).

Background and aims: Spinal anaesthesia in children was first described by Bier in 1898. Since then its popularity amongst anesthesiologists has grown, particularly its applicability in the neonatal and infant patients, where its potential advantages over general anaesthesia can make it a preferable choice. Ultrasonography can be an important resource, since it allows direct visualization of the structures, however, literature related to this topic is sparse, particularly in pediatric patients. We describe four cases in which ultrasound guided spinal anesthesia was successfully performed.
Methods: Four cases of infants undergoing infra-umbilical surgery under USSA in the last three months were studied retrospectively. The four infants were positioned in lateral decubitus and a high frequency linear US transducer was placed in a longitudinal orientation in the medial plane of the spine. After identifying the intervertebral spaces and the dura-mater, lumbar spinal puncture in plane with a 26 G 88 mm Quincke needle and injection of bupivacaine 0,5% (0,5 mg/kg) were performed. Sedation with sevoflurane was maintained for the beginning of the surgery, after which the infants could remain calm with a pacifier. Demographic data, prematurity history, comorbidities, vital parameters, time to onset/duration of surgery, supplementary drugs, complications and discharged were noted.
Results: Mean age was 33/months, 2 preterm infants, ASAII. USSA was successful in all infants, after first attempt. Mean time to onset the surgery was 33min. Motor block was associated with adequate sensory block. Surgery lasted on average 50min without cardiorespiratory complications or conversion to general anesthesia. They were discharged at 2nd postoperative day. 
Discussion and Conclusions: Despiste few cases, this technique appears safe and effective. Ultrasound was used to determine the space and depth to reach within the spinal canal, ensure direct visualization of the needle and proximal structures, avoiding a failed block or neurovascular punctures. No cardiorespiratory repercussion was observed. The technique was rapidly performed and allowed to reduce exposure to general anesthetics at a critical period of development.

Palavras Chave: ultrasound-guided spinal anesthesia, infants, infra-umbilical surgery