背景:三岁以下儿童反复或长时间使用全身麻醉(GA),由于潜在的神经发育影响,应注意。脊柱麻醉(SA)已成为常规儿科泌尿外科手术的安全有效替代方法。在这项研究中,我们描述了SA在新生儿睾丸扭转的紧急手术治疗中的应用。
目的:我们旨在评估SA用于新生儿紧急阴囊探查的安全性和有效性。
方法:我们回顾性收集了2018年5月至2022年6月接受SA治疗的30天以下新生儿睾丸扭转的数据。我们记录了病人的人口统计,辅助药物的使用,以及脊髓注射开始/停止的时间点,procedure,和手术室利用率。
结果:六名新生儿,平均年龄1.9天,平均体重3.4公斤,使用SA进行睾丸扭转的阴囊探查。四名患者(67%)需要对无法存活的扭转睾丸进行睾丸切除术,所有患者均接受未受影响睾丸的睾丸固定术。平均总手术时间为45.3(SD11.7)分钟,包括五名患者的Gomco包皮环切术。一名患者接受术前鼻内右美托咪定镇静。SA给药的平均时间为6.3(SD5.5)分钟,在手术室的平均总时间为77.3(SD9.8)分钟。无围手术期及术后并发症。
结论:我们描述了在SA下手术治疗新生儿扭转的单一机构经验。在这个系列中,SA安全地用于所有涉及的新生儿,而无需转换为GA或静脉(IV)镇静。
结论:使用SA用于新生儿睾丸扭转的紧急阴囊探查是安全有效的,即使是年龄在48小时以下的人。更广泛的使用需要儿科泌尿科医师与受过SA培训的经验丰富的儿科麻醉师之间的合作。
BACKGROUND: The repeated or lengthy use of general anesthesia (GA) in children under three years old is cautioned against due to potential neurodevelopment effects. Spinal anesthesia (SA) has emerged as a safe and effective alternative for routine pediatric urologic procedures. In this study, we describe the use of SA in the urgent surgical treatment of neonatal testicular torsion.
OBJECTIVE: We aim to evaluate the safety and efficacy of SA for urgent scrotal exploration in neonates.
METHODS: We retrospectively collected data on neonates younger than 30 days old undergoing SA for the indication of testicular torsion from May 2018 to June 2022. We recorded patient demographics, adjuvant medications use, and time points for start/stop of spinal injection, procedure, and operating room utilization.
RESULTS: Six neonates, with an average age of 1.9 days of life and average weight of 3.4 kg, underwent scrotal exploration for testicular torsion using SA. Four patients (67%) required orchiectomy of the nonviable torsed testicle, and all patients underwent orchiopexy of the unaffected testicle. Mean total operative time was 45.3 (SD 11.7) minutes, including Gomco circumcision in five patients. One patient received preoperative intranasal dexmedetomidine for sedation. Mean time for SA administration was 6.3 (SD 5.5) minutes, with a mean total time in the operating room of 77.3 (SD 9.8) minutes. There were no perioperative or postoperative complications.
CONCLUSIONS: We describe a single institution experience of surgical management of neonatal torsion under SA. In this case series, SA was safely utilized for all neonates involved without the need for conversion to GA or intravenous (IV) sedation.
CONCLUSIONS: The use of SA is safe and efficacious for urgent scrotal exploration for testicular torsion in neonates, even those under 48 h of age. More widespread utilization requires collaboration between pediatric urologists and experienced pediatric anesthesiologists trained in SA.