Spinal Anesthesia – an Alternative for Infants Undergoing Surgery

A new study highlights the safety and efficacy of more than 1,000 surgeries using spinal anesthesia.

Nationwide Children’s Infant Spinal Anesthesia Program, headed by Grant J. Heydinger, MD, a pediatric attending anesthesiologist in the Department of Anesthesiology & Pain Medicine, recently published the results of a multiyear study of spinal anesthesia for infants undergoing surgery in the Journal of Pediatric Surgery.

“Spinal anesthesia has traditionally been underutilized for surgeries with babies because surgeons and anesthesiologists aren’t, as a whole, as familiar with the approach. It just isn’t used much outside of a few institutions. Through our program, we’ve performed more than 1,000 surgeries using spinal anesthesia and studied the outcomes. The results have been very informative,” Dr. Heydinger says.

The study is a retrospective chart review of infants who underwent spinal anesthesia for surgical procedures at Nationwide Children’s from 2016 until 2022. Data collected included patient demographics, procedure and anesthetic characteristics, intraoperative complications, unplanned admissions, and emergency department returns. Nearly all (98%) of the 1,221 patients were 18 months old or younger.

Spinal anesthesia involves an injection that numbs the lower regions of the body. It does not put a patient to sleep like general anesthesia. This offers several advantages, including faster recovery times, reduced risk of complications such as postoperative nausea and vomiting, and avoiding other potential risks of general anesthesia and unplanned hospital admissions.

“When you put a patient to sleep, you may need to administer a breathing tube, which parents are often apprehensive about. Also, the patient needs to go through a recovery process as they wake up, which causes delays in reuniting parents and their children,” Dr. Heydinger explains.

The study showed that 92% of the patients underwent surgery without requiring conversion to general anesthesia, and 78% did not need any intravenous sedation. No serious intraoperative adverse events occurred. In addition, 72% of the patients bypassed the Post-Anesthesia Recovery Unit Phase I and were immediately reunited with their parents. The median postoperative length of stay was less than 90 minutes. Only seven patients were admitted after surgery despite being assigned ambulatory status. None of the unplanned admissions were due to complications related to spinal anesthesia.

“The significant finding for me was that there were no emergency room or clinic returns because of the type of anesthesia used,” remarks Dr. Heydinger. “This should calm the worries that professionals and parents alike have about the possible side effects or complications that could happen with this novel anesthesia approach.”

Spinal anesthesia is a viable and versatile option for infant surgical procedures. There are numerous potential advantages of spinal anesthesia over general anesthesia in young pediatric patients, particularly in the ambulatory setting.

“At Nationwide Children’s, we’ve found the procedure to be very safe, and kids respond well. We think that spinal anesthesia is well suited for many surgeries in both inpatient and outpatient settings,” Dr. Heydinger concludes.

Reference:

Heydinger G, Roth C, Kidwell R, Tobias JD, Veneziano G, Jayanthi VR, Whitaker EE, Thung AK. A single center’s experience with spinal anesthesia for pediatric patients undergoing surgical procedures. Journal of Pediatric Surgery. 2024 Feb 10:S0022-3468(24)00081-2.

Image credit: Nationwide Children’s