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Spinal anesthesia (SA) has been safely utilized in infants. There are limited data
regarding the safety and efficacy of SA in pediatric urologic surgery lasting ≥60 min.
We outlined the perioperative course for infants undergoing single-injection 0.5%
plain bupivacaine SA-only for urologic procedures lasting ≥60 min.
To characterize the safety and efficacy of SA for urologic surgery in infants lasting
We reviewed our prospectively maintained database of infants undergoing SA for urologic
procedures lasting ≥60 min from May 2018 to March 2021. Patients received preoperative
intranasal dexmedetomidine, some received intranasal fentanyl, and all patients received
lidocaine cream applied preoperatively over the lumbar spine. Oral sucrose on a pacifier
was provided as needed, and the patient's arms were swaddled for the procedure. Success
was defined as no conversion to general anesthesia. Time points for start/end of spinal
injection, procedure duration, wheels in/out of operating room (OR), and discharge
Of 245 cases conducted with SA during the study period, 76 (31%) infants underwent
surgery lasting ≥60 min. Of these, 73 (96%) were successfully completed with SA alone.
In the 3 cases converted to general anesthesia, 2 (67%) required mask anesthesia after
96 and 169 min (for the last <10 min of surgery), and one was converted to intubation
before start of surgery. Median patient age was 6 (IQR 5–7) months, and median procedure
length was 95 (IQR 75–120) minutes. Following initial preoperative intranasal dexmedetomidine ± fentanyl,
at least one additional dose of IV sedative was given in 27 (36%) cases at a median
time of 90 (IQR 60–120) minutes into surgery. Following closure, patients exited the
OR after a median 10 (IQR 8–12) minutes and subsequently discharged after spending
a median of 73 (IQR 61–96) minutes in recovery.
We describe pediatric urologic surgical cases lasting ≥60 min that employed single-injection
intrathecal bupivacaine alone without adjunct intrathecal agents. In this report,
SA was safely utilized in infants undergoing urologic procedures lasting at least
60 min, with about 40% of patients receiving additional IV dexmedetomidine and fentanyl.
Non-medication measures (swaddling, oral sucrose) were important for maximizing patient
comfort. Communication between surgeon and anesthesia as cases progress is key to
maintaining adequate anesthesia.