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A pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair in infants.
Paediatr Anaesth. 2016 Jun; 26(6):621-7.PA

Abstract

BACKGROUND

Recent concerns regarding possible long-term effects of early anesthesia exposure on neurodevelopment in children have provided an impetus to explore alternative anesthetic techniques using potentially neuroprotective agents. Dexmedetomidine has not been implicated in anesthesia-induced neurotoxicity and has been shown to be neuroprotective in preclinical studies. We describe a case series of 50 neonates and infants who received dexmedetomidine sedation with caudal anesthesia instead of general endotracheal anesthesia for inguinal hernia surgery.

METHODS

We conducted a retrospective chart review on all neonates and infants who underwent inguinal hernia surgery with dexemetomidine sedation and caudal anesthesia in our institution. We started exploring this technique since October 2011 and established a protocol of administering dexmedetomidine 2 mcg·kg(-1) over 10 min, followed by 1 mcg·kg(-1) over the next 10 min. This led to satisfactory conditions for caudal placement in 20 min, with minimal need for airway intervention during surgery.

RESULTS

The median gestational age of the infants was 31.4 (28.7, 36.0) weeks and median postconceptual age was 39.7 weeks (IQR 37.8, 45.7) at time of surgery. Of patients, 86% had surgery successfully completed under this technique alone. Seven patients required sevoflurane or nitrous oxide due to failed caudal block (n = 1) or difficult or prolonged surgery (n = 6). After establishing the sedation protocol and excluding patients with large or complicated hernias, the success rate was 96%. Transient intra-operative apnea or hypoventilation occurred in five patients and postoperative apnea in two patients. All respiratory events were easily reversed and no patient developed significant bradycardia or required intubation.

CONCLUSIONS

Dexmedetomidine sedation with caudal anesthesia is a feasible alternative to spinal or general anesthesia in selected infants undergoing uncomplicated hernia surgery. It avoids the need for endotracheal intubation and may be potentially beneficial in avoiding the unknown effects of general anesthesia on neurodevelopment.

Authors+Show Affiliations

Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27061946

Citation

Bong, Choon L., et al. "A Pilot Study of Dexmedetomidine Sedation and Caudal Anesthesia for Inguinal Hernia Repair in Infants." Paediatric Anaesthesia, vol. 26, no. 6, 2016, pp. 621-7.
Bong CL, Yeo AS, Fabila T, et al. A pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair in infants. Paediatr Anaesth. 2016;26(6):621-7.
Bong, C. L., Yeo, A. S., Fabila, T., & Tan, J. S. (2016). A pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair in infants. Paediatric Anaesthesia, 26(6), 621-7. https://doi.org/10.1111/pan.12907
Bong CL, et al. A Pilot Study of Dexmedetomidine Sedation and Caudal Anesthesia for Inguinal Hernia Repair in Infants. Paediatr Anaesth. 2016;26(6):621-7. PubMed PMID: 27061946.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair in infants. AU - Bong,Choon L, AU - Yeo,Angela S H, AU - Fabila,Teddy, AU - Tan,Josephine S K, Y1 - 2016/04/07/ PY - 2016/03/15/accepted PY - 2016/4/11/entrez PY - 2016/4/12/pubmed PY - 2017/3/4/medline KW - MeSH terms: dexmedetomidine KW - caudal anesthesia KW - sedation SP - 621 EP - 7 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 26 IS - 6 N2 - BACKGROUND: Recent concerns regarding possible long-term effects of early anesthesia exposure on neurodevelopment in children have provided an impetus to explore alternative anesthetic techniques using potentially neuroprotective agents. Dexmedetomidine has not been implicated in anesthesia-induced neurotoxicity and has been shown to be neuroprotective in preclinical studies. We describe a case series of 50 neonates and infants who received dexmedetomidine sedation with caudal anesthesia instead of general endotracheal anesthesia for inguinal hernia surgery. METHODS: We conducted a retrospective chart review on all neonates and infants who underwent inguinal hernia surgery with dexemetomidine sedation and caudal anesthesia in our institution. We started exploring this technique since October 2011 and established a protocol of administering dexmedetomidine 2 mcg·kg(-1) over 10 min, followed by 1 mcg·kg(-1) over the next 10 min. This led to satisfactory conditions for caudal placement in 20 min, with minimal need for airway intervention during surgery. RESULTS: The median gestational age of the infants was 31.4 (28.7, 36.0) weeks and median postconceptual age was 39.7 weeks (IQR 37.8, 45.7) at time of surgery. Of patients, 86% had surgery successfully completed under this technique alone. Seven patients required sevoflurane or nitrous oxide due to failed caudal block (n = 1) or difficult or prolonged surgery (n = 6). After establishing the sedation protocol and excluding patients with large or complicated hernias, the success rate was 96%. Transient intra-operative apnea or hypoventilation occurred in five patients and postoperative apnea in two patients. All respiratory events were easily reversed and no patient developed significant bradycardia or required intubation. CONCLUSIONS: Dexmedetomidine sedation with caudal anesthesia is a feasible alternative to spinal or general anesthesia in selected infants undergoing uncomplicated hernia surgery. It avoids the need for endotracheal intubation and may be potentially beneficial in avoiding the unknown effects of general anesthesia on neurodevelopment. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/27061946/A_pilot_study_of_dexmedetomidine_sedation_and_caudal_anesthesia_for_inguinal_hernia_repair_in_infants_ L2 - https://doi.org/10.1111/pan.12907 DB - PRIME DP - Unbound Medicine ER -