Use of spinal anaesthesia in neonates and infants in Antananarivo, Madagascar: a retrospective descriptive study
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RESEARCH NOTE
Use of spinal anaesthesia in neonates and infants in Antananarivo, Madagascar: a retrospective descriptive study Harifetra M. R. Randriamizao1, Aurélia Rakotondrainibe1,5* , Lova D. E. Razafindrabekoto2, Prisca F. Ravoaviarivelo3, Andriambelo T. Rajaonera1 and Mamy L. Andriamanarivo4
Abstract Objective: The aim of this study was to present the first cases of spinal anesthesia, in newborns and infants, preterm/ ex-prematures, in order to determine its feasibility and its potential harmlessness, in Antananarivo—Madagascar. Indeed, spinal anesthesia is a low cost technique and can limit respiratory complications, postoperative apnea a contrario with pediatric general anesthesia which can lead to perioperative risks. Results: In a retrospective, descriptive, 7-year (2013 to 2019) period study, conducted in the University Hospital Joseph Ravoahangy Andrianavalona, 69 patients’ data files planned to have spinal anesthesia were recorded. These pediatric patients were predominantly male (sex ratio = 2.8) and 37 [28–52] days old. The smallest anesthetized child weighed 880 g; the youngest was 4 days old. Twenty-seven (27) of them were premature and 20.3% presented respiratory diseases. They were mostly scheduled for hernia repair (90%). Spinal anesthesia was performed, with a Gauge 25 Quincke spinal needle, after 2 [1–2] attempts with hyperbaric bupivacaine of 4 [3.5–4] mg. Failure rate was 5.8%. The heart rate was stable throughout perioperative period and no complications were observed. Keywords: Spinal anesthesia, Newborns, Infants, Preterm, Ex prematures, Madagascar Introduction Spinal anesthesia (SA) is a part of anesthesia for sub umbilical and lower limb surgeries [1]. The first spinal anesthesia in children had been practiced by Bier in the nineteenth century (1898), then by Bainbridge (1901) and Gray (1909) [1, 2]. Due to considerable improvements of general anesthesia (GA) in the middle of twentieth century, this regional anesthesia was abandoned [2]. In 1990–2000, spinal anesthesia in newborns or in preterm had an upsurge of 2.1 to 3.6% in regional anesthesia after the decline of caudal anesthesia practice [3, 4]. Nowadays, SA tends to be mainly performed in pediatric anesthesia,
up to 95.4% of children, as much in the newborns as in the preterm [1–3, 5]. SA allows the prevention and the reduction of perioperative complications even if its duration is an important limiting factor [1–3, 6]. Because of this limitation, short surgery is the most indicated under SA [1, 5, 7]. For more efficiency, this technique should be performed by experimented anesthetists [1, 8]. In Antananarivo—Madagascar, at the Hospital University of JR Andrianavalona (CHU JRA), spinal anesthesia has been performed since 2013. The aim of this study is to present the first cases of spinal anesthesia, in newborns and infants, preterm / ex-prematures, in order to
*Correspondence: [email protected] 1 Department of Anesthesia and Intensive Care, University of Antananarivo, Antana
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