Caudal block, high flow oxygen insufflation and dexmedetomidine sedation for inguinal hernia surgery in infants—A prospective evaluation of an alternative anesthesia technique (2025)

Taverner, F. J., Burgoyne, L. L., Scott-Weekly, R., van der Griend, B. F., Chooi, C. S. L., Khurana, S., Humphreys, S. R., Lemaqz, S., Morris, S., Roberts, C. T., & von Ungern-Sternberg, B. S. (2024). Caudal block, high flow oxygen insufflation and dexmedetomidine sedation for inguinal hernia surgery in infants—A prospective evaluation of an alternative anesthesia technique. Paediatric Anaesthesia. Advance online publication. https://doi.org/10.1111/pan.15040

Taverner, Fiona J. ; Burgoyne, Laura L. ; Scott-Weekly, Ross et al. / Caudal block, high flow oxygen insufflation and dexmedetomidine sedation for inguinal hernia surgery in infants—A prospective evaluation of an alternative anesthesia technique. In: Paediatric Anaesthesia. 2024.

@article{b7d263c8d34e4312a3955d60e2df6fd4,

title = "Caudal block, high flow oxygen insufflation and dexmedetomidine sedation for inguinal hernia surgery in infants—A prospective evaluation of an alternative anesthesia technique",

abstract = "Background: Inguinal hernia repair is the most common operation in infants, with well recognized anesthetic and perioperative risks. The aim was to investigate if the combination of caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is suitable for infants undergoing inguinal hernia surgery.Methods: A prospective multicenter international study was performed in three centers in Australia and New Zealand. Fifty infants less than 64 weeks post-menstrual age undergoing inguinal hernia surgery were enrolled. Exclusion criteria were any condition that contraindicated the use of the anesthesia technique. The technique included intravenous dexmedetomidine with a loading dose of 1–2 mcg/kg over 10 min and maintenance of 0.2–3 mcg/kg/h, high-flow nasal oxygen insufflation 2 L/kg/min with an oxygen blender, and a caudal block using 1 mL/kg 0.2% ropivacaine. The primary outcome was the successful completion of surgery without conversion to general anesthesia.Results: Completion of surgery with the technique was successful in 41/50 (82%) infants. Care was provided by 22 anesthesiologists and 11 surgeons. Infants had a low incidence of intraoperative complications, including apnea [1 (2.4%)], bradycardia [2 (4.9%)], hypotension [2 (4.9%)], and desaturation [1 (2.4%)]. Postoperative complications included apnea [3 (7.3%)], bradycardia [3 (7.3%)], hypotension [3 (7.3%)], desaturation [4 (9.8%)]. No infants were intubated in the first 24 h postoperatively.Conclusion: Caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is a potential alternative to general anesthesia for infant inguinal hernia surgery with a low rate of complications in this small cohort of infants.",

keywords = "caudal, dexmedetomidine, high-flow, infant, inguinal hernia",

author = "Taverner, {Fiona J.} and Burgoyne, {Laura L.} and Ross Scott-Weekly and {van der Griend}, {Benjamin F.} and Chooi, {Cheryl S.L.} and Sanjeev Khurana and Humphreys, {Susan R.} and Shalem Lemaqz and Scott Morris and Roberts, {Claire T.} and {von Ungern-Sternberg}, {Britta S.}",

year = "2024",

month = nov,

day = "7",

doi = "10.1111/pan.15040",

language = "English",

journal = "Paediatric Anaesthesia",

issn = "1155-5645",

publisher = "Wiley-Blackwell Publishing Ltd",

}

Taverner, FJ, Burgoyne, LL, Scott-Weekly, R, van der Griend, BF, Chooi, CSL, Khurana, S, Humphreys, SR, Lemaqz, S, Morris, S, Roberts, CT & von Ungern-Sternberg, BS 2024, 'Caudal block, high flow oxygen insufflation and dexmedetomidine sedation for inguinal hernia surgery in infants—A prospective evaluation of an alternative anesthesia technique', Paediatric Anaesthesia. https://doi.org/10.1111/pan.15040

Caudal block, high flow oxygen insufflation and dexmedetomidine sedation for inguinal hernia surgery in infants—A prospective evaluation of an alternative anesthesia technique. / Taverner, Fiona J.; Burgoyne, Laura L.; Scott-Weekly, Ross et al.
In: Paediatric Anaesthesia, 07.11.2024.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Caudal block, high flow oxygen insufflation and dexmedetomidine sedation for inguinal hernia surgery in infants—A prospective evaluation of an alternative anesthesia technique

AU - Taverner, Fiona J.

AU - Burgoyne, Laura L.

AU - Scott-Weekly, Ross

AU - van der Griend, Benjamin F.

AU - Chooi, Cheryl S.L.

AU - Khurana, Sanjeev

AU - Humphreys, Susan R.

AU - Lemaqz, Shalem

AU - Morris, Scott

AU - Roberts, Claire T.

AU - von Ungern-Sternberg, Britta S.

PY - 2024/11/7

Y1 - 2024/11/7

N2 - Background: Inguinal hernia repair is the most common operation in infants, with well recognized anesthetic and perioperative risks. The aim was to investigate if the combination of caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is suitable for infants undergoing inguinal hernia surgery.Methods: A prospective multicenter international study was performed in three centers in Australia and New Zealand. Fifty infants less than 64 weeks post-menstrual age undergoing inguinal hernia surgery were enrolled. Exclusion criteria were any condition that contraindicated the use of the anesthesia technique. The technique included intravenous dexmedetomidine with a loading dose of 1–2 mcg/kg over 10 min and maintenance of 0.2–3 mcg/kg/h, high-flow nasal oxygen insufflation 2 L/kg/min with an oxygen blender, and a caudal block using 1 mL/kg 0.2% ropivacaine. The primary outcome was the successful completion of surgery without conversion to general anesthesia.Results: Completion of surgery with the technique was successful in 41/50 (82%) infants. Care was provided by 22 anesthesiologists and 11 surgeons. Infants had a low incidence of intraoperative complications, including apnea [1 (2.4%)], bradycardia [2 (4.9%)], hypotension [2 (4.9%)], and desaturation [1 (2.4%)]. Postoperative complications included apnea [3 (7.3%)], bradycardia [3 (7.3%)], hypotension [3 (7.3%)], desaturation [4 (9.8%)]. No infants were intubated in the first 24 h postoperatively.Conclusion: Caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is a potential alternative to general anesthesia for infant inguinal hernia surgery with a low rate of complications in this small cohort of infants.

AB - Background: Inguinal hernia repair is the most common operation in infants, with well recognized anesthetic and perioperative risks. The aim was to investigate if the combination of caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is suitable for infants undergoing inguinal hernia surgery.Methods: A prospective multicenter international study was performed in three centers in Australia and New Zealand. Fifty infants less than 64 weeks post-menstrual age undergoing inguinal hernia surgery were enrolled. Exclusion criteria were any condition that contraindicated the use of the anesthesia technique. The technique included intravenous dexmedetomidine with a loading dose of 1–2 mcg/kg over 10 min and maintenance of 0.2–3 mcg/kg/h, high-flow nasal oxygen insufflation 2 L/kg/min with an oxygen blender, and a caudal block using 1 mL/kg 0.2% ropivacaine. The primary outcome was the successful completion of surgery without conversion to general anesthesia.Results: Completion of surgery with the technique was successful in 41/50 (82%) infants. Care was provided by 22 anesthesiologists and 11 surgeons. Infants had a low incidence of intraoperative complications, including apnea [1 (2.4%)], bradycardia [2 (4.9%)], hypotension [2 (4.9%)], and desaturation [1 (2.4%)]. Postoperative complications included apnea [3 (7.3%)], bradycardia [3 (7.3%)], hypotension [3 (7.3%)], desaturation [4 (9.8%)]. No infants were intubated in the first 24 h postoperatively.Conclusion: Caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is a potential alternative to general anesthesia for infant inguinal hernia surgery with a low rate of complications in this small cohort of infants.

KW - caudal

KW - dexmedetomidine

KW - high-flow

KW - infant

KW - inguinal hernia

UR - http://www.scopus.com/inward/record.url?scp=85208543065&partnerID=8YFLogxK

UR - http://purl.org/au-research/grants/NHMRC/2009322

U2 - 10.1111/pan.15040

DO - 10.1111/pan.15040

M3 - Article

AN - SCOPUS:85208543065

SN - 1155-5645

JO - Paediatric Anaesthesia

JF - Paediatric Anaesthesia

ER -

Taverner FJ, Burgoyne LL, Scott-Weekly R, van der Griend BF, Chooi CSL, Khurana S et al. Caudal block, high flow oxygen insufflation and dexmedetomidine sedation for inguinal hernia surgery in infants—A prospective evaluation of an alternative anesthesia technique. Paediatric Anaesthesia. 2024 Nov 7. Epub 2024 Nov 7. doi: 10.1111/pan.15040