الفهرس 
Anatomical considerationsOnly 14 pages are availabe for public view
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Abstract
The aim of this essay is to assess the safety and efficacy of spinal anaesthesia in infants undergoing surgery appropriate for this technique. Spinal anaesthesia in pediatrics was first introduced in the United States by Bainbridge in 1901. Bainbridge reported over 40 operations performed under spinal anaesthesia, one of them in a 3-month old infant.
To safely and proficiently administer a spinal anaesthetic in infants, it is crucial to understand the anatomic differences between adults and infants regarding termination of spinal cord and dural sac, surface anatomy, and volume of CSF. The spinal cord and dural sac terminate at a more caudad level in infants with the conus medullaris ending at approximately the L2 or L3 level in infants versus the L1 level in adults. Therefore, to avoid potential injury to the spinal cord, dural puncture should be performed below the level termination of the spinal cord; below L2–L3 in infants.
Understanding the pharmacology of local anaesthetics enables the anaesthetist to predict the potency, speed of onset, duration of action and safety of a specific drug in administrating spinal anaesthesia in infants. Local anaesthetic drugs interfere with neuronal cell membrane excitation and subsequent conduction of action potentials in the nervous system, as well as in the heart, by blockade of the voltage-gated Na- channels.
The most important concern with the use of intrathecal local anaesthetics in infants and young children is the risk of toxicity. This age group is particularly prone to direct toxicity to the spinal cord when administered in large doses. With the increase in popularity of regional techniques and the increasing use of local anaesthetic agents outside of anaesthetic practice, the need for a better understanding of toxicity is as great now as it was 100 years ago. The advent of lipid emulsion therapy offers a treatment for toxicity, and its widespread adoption has highlighted the dangers.
Never the less, prevention remains the best treatment and new recommendations for labelling, storing and administrating local anaesthetics are in force. Good practice includes checking for intravascular insertion of needle/catheter, fractionating the dose and close observation of the patient. If toxicity does occur after the control of seizures and the institution of CPR, the use of lipid emulsion therapy will hopefully improve the outcome of refractory arrests.
Spinal anesthesia is not only a safe alternative to general anaesthesia but often the anaesthesia technique of choice in many lower abdominal and lower limb surgeries in infants. misconception regarding its safety and feasibility is broken and is now found to be even more cost-effective. It is a much preferred technique especially for the common day case surgeries generally performed in the paediatric age group. There is no requirement of any additional expensive equipment either and this procedure can be easily performed in peripheral centers. However, greater acceptance and experience is yet desired for this technique to become popular.