Infant Spinal Anesthesia Indications: 1) Short procedures (less than 1.5 hrs) 2) Preterm infants under the age of 60 wks postconceptional (prone to apnea) Term infants under the age of 44 wks (prone to apnea) 3) Surgical procedures of patients at any age where the site of the operation is below T10 and extrapertioneal. Some anesthesiologists have successfully used this for surgeries such as gastoschisis. Anesthetic Solutions and Doses for Infants (<12 months): Interestingly infant spinals last for a shorter duration and require a significantly higher dose of spinal local anesthetics when compared to an adult. Agent Mean Dose Level Duration __________________________________________________________________ Tetracaine O.5% hyperbaric Tetracaine 0.5% hyperbaric/epi Bupivacaine 0.5% isobaric Bupivacaine 0.75% hyperbaric/epi 0.4 mg/kg* 0.4-0.8 mg/kg* 0.8 mg/kg* 0.6 mg/kg* T3* T3* T3* T3* 86 min* 80-128 min* 80-125 min* <75* *Commonly accepted dosing values compounded from multiple studies. Physiological responses: Respiratory: Similar to adults - weakness occurs with loss of abdominal musculature. Extreme care should be taken not to place the patient in a position where the upper body is in a dependent after placement. This can lead to a total spinal – not uncommon during placement of Bovie pad!!! Cardiac: Many studies report no hypotension or bradycardia with a high spinal for patients < 5 yrs of age. Technique: Remember a newborns Conus Medullaris ends at L3 and not L1 like adults so aim for L3-4 or below. Position: Sitting or supine with a dedicated person to hold and flex the infant. Sitting position is usually preferred as it allows somewhat easier access to the midline in this age group. Needle: 1 inch (or shorter) 25 guage. Depth: Much shallower than you think. There is a depth insertion chart located near the anesthesia carts in the pedi rooms. Make sure to check for CSF often. Complications: Similar to adult spinals but the most common is respiratory depression secondary to high spinal. Infants must be closely monitored for this reason and all equipment for full resuscitation must be immediately available and ready to go. Postdural puncture headache is thought to be rare among infant.