الفهرس 
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Abstract
The clinical data support the efficacy of spinal anesthesia in the pediatric population. Spinal anesthesia provides an excellent alternative to general anesthesia in newborns with increased anesthesia-related risk, and for infants undergoing lower abdominal or lower extremity surgery during the first six months of life with the incidence of serious complications associated with it being very low, even in small premature infants. It is most successful as a single-shot technique, limited to surgery lasting less than 90 minutes. Spinal anesthesia in children requires the technical skills of experienced anesthesia providers. Spinal anesthesia is a speedy technique in children and, consequently, it allows for rapid turnover in the operating theatre. Access to the subarachnoid space in children is simple, and therefore the technique is easy to learn for every anesthetist.
For spinal anesthesia in the pediatric group, we should use thin spinal needles with a stylet because a 22-gauge needle is associated with a two- to three-fold higher incidence of PDPH compared with 25- to 27-gauge needles. A 50-mm 25-gauge spinal needle is feasible for young children, while a 90-mm 27-gauge needle can be used for school-age children and adolescents.
Bupivacaine at a dose of 0.3 ± 0 .4 mg/kg in children up to 7 years of age and a dose of 0.25 ± 0.3 mg/kg in older children produces a sensory block to T3 - T5 with a duration of 75 ± 85 minutes. Both hyperbaric and isobaric bupivacaine solutions can be used. When prolonged analgesia is desired, either combined spinal-epidural anesthesia or additive use are convenient choices.
There appear to be two distinct groups of infants that benefit from spinal anesthesia. The hospitalized infant with respiratory difficulties is less likely to require prolonged mechanical ventilation if surgeons want to successfully perform hernia repair or other abdominal surgeries without endotracheal intubation. The other group is the infant having an outpatient inguinal hernia repair. These infants have a lower incidence and severity of postoperative oxygen desaturations with spinal anesthesia compared with general anesthesia. However, there is an ongoing debate: at what PCA does general and spinal anesthesia have comparable outcomes in infants? Multiple case series reports further support the clinical effectiveness of spinal anesthesia in high-risk infants. However, the overall number of infants studied remains small, with a limited number of institutions reporting results. Anesthetists are obligated to careful follow-up of their patients. Balancing of relative risks defines the practice of medicine. Experience and attention to detail are crucial to the success of spinal anesthesia in neonates and infants, which are at high risk of complications during surgery, irrespective of the type of anesthesia, and the presence of clinicians trained in pediatric anesthesiology is mandated.