Pediatric anesthesia & critical care
Second infant spinal anesthetic: Incidence, dose modification, and adverse events after initial failure
Authors' conclusion
Infant spinal anesthesia is associated with high success rates if experienced anesthetists are present or performing the block. Repeat spinal anesthesia may be associated with an increased incidence of high spinal block.
Study context
- Population
- Infants (premature and ex-premature) receiving spinal anaesthesia, May 2016 to June 2023mean postmenstrual age 42.9 weeks
- Participants
- 551 infants
- Outcome
- Overall spinal failure rate, incidence of second spinal attempts and adverse events with a second spinal anesthetic
Methodological detailssingle-centre, quaternary centre
- Single-centre
- Quaternary centre
Main finding
As reported in the abstract
Spinal anesthesia success and failure
- Success on first attempt
- 86.5%
- Successful second spinal after initial failure
- 5.1%
- Failure requiring conversion to GA
- 9.4%
- Repeat spinal performed after initial failure (cases)
- 28
- Repeat spinal successful
- 92.8%
- Awake caudal successful (after initial failure)
- 7.2%
Observational data: associations, not effects.
Further findings
| Outcome | Styletted | Non styletted | OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Spinal failure by anesthetist performing <5 spinals per year | 2.21 (1.28–3.83) | P = 0.004 | |||
| Spinal failure by needle type | 21.4% | 9.2% | 2.68 (1.23–5.86) | P = 0.012 | |
| 0.20.5125Odds ratio (log scale) |
- Spinal failure by anesthetist performing <5 spinals per year: only weakly associated with years of pediatric anesthetic experience
Causes of failed spinal anesthetic
- Dry tap
- 4.2%
- Inadequate motor blockade
- 2.9%
- Repeated bloody taps
- 2.2%
Safety
Perioperative apnoea
- Overall incidence
- 6.7%
- Failed spinal converted to GA (highest rate)
- 25%
High spinal blockade
- Total cases
- 3
- After a single spinal
- 1
- After a repeat spinal (both required intubation and brief resuscitation)
- 2
Original publication
Second infant spinal anesthetic: Incidence, dose modification, and adverse events after initial failure. Paediatr Anaesth. Published 26 December 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →