Is spinal anaesthesia in young infants really safer and better than general anaesthesia?

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Purpose of review

Concerns regarding the potential neurotoxic effects of general anaesthesia have seen resurgence in awake spinal anaesthesia in neonates and infants. This review includes recently published data from a large prospective randomized controlled trial with view to determining if spinal anaesthesia is safer and better than general anaesthesia in this population.

Recent findings

Compared with general anaesthesia, spinal anaesthesia results in less haemodynamic instability and fewer early (<30 min) apnoeic episodes in neonates and infants undergoing inguinal herniorraphy; the overall incidence of apnoeas in the first 12 h postoperatively was similar. Neurodevelopmental outcome 2 years postoperatively was similar. An appreciable failure rate for spinal anaesthesia was confirmed.


Spinal anaesthesia represents a suitable alternative to general anaesthesia in neonates and infants undergoing minor surgery avoiding the need for endotracheal intubation and ventilation. Spinal anaesthesia has some advantages but a significant failure rat and has not been demonstrated to improve neurodevelopmental outcome.

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