Spinal anaesthesia in paediatrics

The use of spinal anaesthesia in children has been primarily limited to situations in which general anaesthesia was considered to pose an excessive risk. The ex-premature infant and the neurologically impaired child account for the majority of spinal anaesthetics used today. Spinal anaesthesia, compared with general anaesthesia, in the ex-premature infant undergoing inguinal hernia repair has decreased postoperative respiratory complications (e.g. apnoeic events, prolonged mechanical ventilation). Hyperbaric tetracaine and bupivacaine solutions are the local anaesthetics of choice. Haemodynamic stability is well preserved in neonates having spinal anaesthesia. Advances in spinal needle design have decreased the incidence of postdural puncture headache (PDPH). Catastrophic events have occurred with neuraxial techniques. Care must be taken in evaluating the relative risks of anaesthetic approaches in infants and children.