Case report: Multimodal spinal anesthesia in a pediatric patient with a difficult airway
Abstract
Introduction: Spinal anesthesia has been part of the pediatric anesthesia practice for more than 100 years. Its use has been increasing in recent years because of its effectiveness, efficiency and safety. We report a successful case in a patient with a difficult airway.
Objective: To report a case of spinal anesthesia and sedation with remifentanil, together with a review of the literature including alpha 2 agonists for locoregional procedures in pediatrics.
Methods: Search of relevant references in PubMed, MD consult and BIREME. The search resulted in 306 articles, and 23 considered relevant by the authors were finally selected.
Results: We present a case of a 1-year-old boy with an expected difficult airway because of the presence of a cavernous hemangioma of the lower lip, scheduled for surgical correction of bilateral club foot. Spinal anesthesia consisted of 0.5% hyperbaric carbonated bupiva-caine plus 30 |xg of clonidine (1.3 ml total), maintaining sedation-analgesia at 3—4/6 on the Ramsay scale with remifentanil 0.05-0.075 |xg/kg/min, 50% oxygen with facial mask, and spontaneous ventilation, with no hemodynamic or respiratory adverse effects.
Conclusions: Spinal anesthesia is an option in cases of predicted difficult airway. Clonidine (alpha 2 agonist) prolongs blockade with no hemodynamic or respiratory complications. Remifentanil used for sedation in pediatric locoregional procedures is easy to titrate with predictable results.
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