Spinal anaesthesia in infants and children

Every anaesthetist who deals with paediatric patients should have the expertise to perform spinal anaesthesia. Often, children undergoing surgery in the lower part of the body have contraindications for general anaesthesia; in these children spinal anaesthesia is a convenient option. The aim of anaesthesia is to provide good operating conditions for the surgeon while avoiding any harmful psychological sequelae for the child. In addition, the anaesthetistʹs goal is to lessen the physiological stress response to surgery and to prevent post-operative morbidity. In children, spinal anaesthesia produces a dense intra-operative analgesia and, when combined with general anaesthesia, it reduces the requirements for anaesthetic agents and opioids intra-operatively. Spinal anaesthesia allows a fast return to a bright and alert status, and a rapid return of normal appetite. Following spinal anaesthesia, analgesia continues into the early post-operative period, and nausea and vomiting are uncommon. Consequently, ambulation and discharge are not delayed. Some children develop complications following spinal anaesthesia—for example, a post-lumbar puncture headache and transient neurological symptoms. In young children these symptoms may be difficult to perceive if parents are not informed. When long-lasting, these symptoms may surpass the benefits of spinal anaesthesia and should therefore be identified and treated appropriately.