Anestesia subaracnóidea em crianças

Norma Sueli Pinheiro Módolo; Yara Marcondes Machado Castiglia

doi:10.1590/S0034-70942001000600009

Review Article

Anestesia subaracnóidea em crianças

Spinal anesthesia in children

Norma Sueli Pinheiro Módolo; Yara Marcondes Machado Castiglia

http://dx.doi.org/10.1590/S0034-70942001000600009 Braz J Anesthesiol, vol.51, n6, p.537-547, 2001

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JUSTIFICATIVA E OBJETIVOS: Tem aumentado muito o emprego da anestesia subaracnóidea em crianças, principalmente neonatos com risco de desenvolver apnéia neonatal. O objetivo deste trabalho foi rever as diferenças anatômicas, fisiológicas e farmacológicas desta técnica em crianças. CONTEÚDO: A anestesia subaracnóidea em crianças, apesar de ter sido técnica empregada desde o início do século XX, teve sua popularidade diminuída com o advento dos anestésicos inalatórios e bloqueadores neuromusculares, para ser novamente resgatada em 1979. As características favoráveis desta técnica em pediatria são relativas à estabilidade cardiovascular, em crianças de até 8 anos de idade, à analgesia satisfatória e ao relaxamento muscular. Os anestésicos mais utilizados em crianças são a tetracaína e a bupivacaína, cujas doses são ajustadas tomando-se por base o peso corporal. Esta técnica é limitada pela duração relativamente curta, devendo ser utilizada para procedimentos cirúrgicos que não ultrapassem 90 minutos e também pela analgesia não abranger o pós-operatório. As complicações são as mesmas encontradas no paciente adulto, incluindo cefaléia por punção dural e irritação radicular transitória. As indicações são várias: cirurgias de abdômen inferior, genitália, membros inferiores, região perineal e, em alguns casos, até em cirurgias torácicas. Seu emprego tem particular interesse nos recém-nascidos prematuros, pelo risco de apresentarem a apnéia da prematuridade. CONCLUSÕES: A anestesia subaracnóidea em crianças é técnica relativamente segura, com poucas complicações e pode ser considerada como opção para anestesia geral, principalmente nos recém-nascidos prematuros com risco de apresentarem complicações respiratórias no pós-operatório.

Palavras-chave

ANESTESIA, TÉCNICAS ANESTÉSICAS, Regional

Abstract

Background and Objectives: Pediatric spinal anesthesia has gained popularity mainly as an alternative to general anesthesia in pre-term neonates at risk for developing neonatal apnea. This study aimed at evaluating anatomic, physiologic and pharmacological differences of the technique in children. Contents: Spinal anesthesia in children is being used since the early 20th century, but was overlooked for many years due to the introduction of inhalational anesthetics and neuromuscular blockers. It regained popularity in 1979. Its positive effects in pediatric anesthesia are cardiovascular stability in children up to 8 years of age, satisfactory analgesia and muscle relaxation. Most popular pediatric anesthetics are tetracaine and bupivacaine in doses adjusted to body weight, but this technique is limited by a relatively short duration of anesthesia. Surgical procedures cannot last more than 90 min and there is no satisfactory postoperative pain control. Complications are the same for adult patients and include post-dural puncture headache and transient radicular irritation. Indications are: lower abdomen, genitalia, perineal region, lower limbs and, in some cases, even thoracic surgeries. It is particularly attractive for pre-term neonates at higher risk for postoperative apnea after general anesthesia. Conclusions: Spinal anesthesia in children is a relatively safe technique with few complications and may be considered an alternative for general anesthesia, especially for pre-term neonates at risk for postoperative respiratory complications.

Keywords

ANESTHESIA, ANESTHETIC TECHNIQUES, Regional

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Anestesia subaracnóidea em crianças

Spinal anesthesia in children

Norma Sueli Pinheiro Módolo; Yara Marcondes Machado Castiglia

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