Spinal and caudal anaesthesia in ex-premature babies

Spinal and caudal anaesthesia have become valuable techniques for herniotomies and lower abdominal surgery in former preterm infants. Despite the lack of clear scientific evidence, many paediatric anaesthetists assume that post-operative apnoea can be largely prevented in these patients by pure regional anaesthetic techniques. Post-operative apnoea does occur in former preterm infants after general anaesthesia up to a post-conceptual age of 50–60 weeks. Whereas spinal anaesthesia has been compared to general anaesthesia in a few prospective and controlled studies, there are, so far, no randomized studies on caudal anaesthesia, and there are also no studies comparing spinal with caudal anaesthesia. This chapter provides physiological and practical knowledge concerning spinal and caudal anaesthesia in ex-premature babies. Current scientific data are analysed, and the authorʹs personal experience and opinion are presented.