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

Whitaker et al the potential respiratory effects of insufflation without airway control and mechanical ventilation. The obvious concern regarding the use of spinal anesthesia in this scenario was the potential for adverse effects on hemodynamic function. However, spinal anesthesia (even high blockade) has limited effects on hemodynamic function in infants and children <6 years of age. [32] [33] [34] This has traditionally been attributed to the incomplete development of the sympathetic nervous system in infants. 34 However, analysis of heart rate variability during the administration of spinal anesthesia in infants suggests that the reflex response to high spinal anesthesia is a primarily diminished parasympathetic tone that offsets the blockade of sympathetic function. 35 In our patient, no clinically significant changes in heart rate, blood pressure, or oxygen saturation were noted after the administration of spinal anesthesia. Despite these data, the potential for hemodynamic changes should always be considered and appropriate monitoring employed with ready access to resuscitation medications if needed. For obvious reasons, we selected spinal anesthesia in the patient due to spinal anesthesia's remarkable cardiovascular stability, which has been well documented.