Spinal anesthesia after intraoperative cardiac arrest during general anesthesia in an infant

Whitaker, Emmett E; Miler, Veronica; Bryant, Jason; Proicou, Stephanie; Jayanthi, Rama; Tobias, Joseph D

Spinal anesthesia anesthesia program has been developed. The parents were enthusiastic about the possibility of avoiding general anesthesia and informed consent was obtained for spinal anesthesia. On the morning of presentation for the second surgery, the patient's weight was 10.3 kg and his vital signs were normal. There was no history of recent viral illness and the patient appeared well. In the preoperative area, LMX ® cream (4% topical lidocaine; Ferndale Laboratories Inc, Ferndale, MI, USA) was applied to the lumbar area to minimize discomfort with the placement of the spinal needle. After arrival to the operating room, the patient was placed in the sitting position. After sterile preparation, the intrathecal space was accessed on the first attempt, using a 1.5-inch, 22-gauge spinal needle. Upon return of cerebrospinal fluid, 1 mL of 0.5% isobaric bupivacaine containing clonidine (10 µg) was administered. We typically add clonidine to the local anesthetic in order to provide long-lasting pain relief after surgery. The patient was then placed in the supine position, standard American Society of Anesthesiologists' monitors were placed, and a 22-gauge peripheral intravenous catheter was placed in the left foot. Immediate motor and sensory block were noted. The surgery was started and initial operating conditions were excellent. Due to the patient's irritability, a single dose of dexmedetomidine (7.5 µg) was administered intravenously during the first 15 minutes of the procedure. Dexmedetomidine is our first-line sedative of choice (if sedatives are needed) due to its minimal respiratory depression. Thereafter, the surgery (bilateral inguinal orchidopexy) was able to be completed with excellent operating conditions. The patient was hemodynamically stable throughout the operation, which lasted ~1 hour and 25 minutes. He required no further sedation. His post-anesthesia care unit stay was uncomplicated, and he was discharged to home that afternoon without incident.