Combined spinal and caudal epidural anesthesia for ureteral reimplantation in pediatric patients: A case series

Objective: To demonstrate the use of a combination of spinal and caudal epidural anesthesia instead of general for prolonged urologic procedures. The technique involves single shot spinal anesthesia (SA) followed by placement of a caudal epidural catheter for prolongation of surgical anesthesia when the effects of SA dissipate. Methodology: We retrospectively report the successful use of the technique in six infants undergoing ureteral reimplantation with a surgical duration of 110 to 166 min (mean 129 min, median 126.5 min). Results: Combined spinal and caudal epidural anesthesia was successful in all 6 infants. In one infant, SA provided surgical anesthesia for the duration of the case so the caudal epidural catheter was not dosed. Sedation was provided by dexmedetomidine with an initial bolus dose (0.6-1.5 μg/kg) in all 6 patients. Five of the 6 patients then received an infusion of dexmedetomidine (0.5-1.0 μg/kg/hour). Four of the 5 patients who received a dexmedetomidine infusion received one additional bolus dose (0.5-1 μg/kg) due to inadequate sedation, patient movement, or increased heart rate. Conclusions: Combined spinal and caudal epidural anesthesia can be used as an alternative to general anesthesia for prolonged urologic procedures. The technique is described and previous reports of combined spinal and caudal epidural anesthesia in infants reviewed.