Anesthesiology of the Newborn with Spina Bifida

  • Nigar Baykan


Neural tube malformations involving the spinal cord and vertebral arches are referred to as spina bifida and present as a spectrum of malformations with protrusion of the spinal cord and/or meninges through a defect in the vertebral arch at the most severe end. Neural tube defects do not appear to be associated with other congenital syndromes; however, cardiac and renal anomalies which may not be apparent at birth may co-exist, prompting an in-depth assessment of these children. Additionally, children with spina bifida often have hydrocephalus and the Chiari type II malformation in association.


Spina Bifida Tracheal Tube Minimal Alveolar Concentration Pediatric Anesthesia Latex Allergy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Northrup H, Volcik KA (2000) Spina bifida and other neural tube defects. Curr Probl Pediatr 30:312-332Google Scholar
  2. 2.
    Steinbok P, Irvine B, Cochrane DD, Irwin BJ (1992) Long-term outcome and complications of children born with myelomeningocele. Child Nerv Syst 8:92–96CrossRefGoogle Scholar
  3. 3.
    Oakeshott P, Hunt GM (2003) Long-term outcome in open spina bifida. Br J General Practice 53:632–636Google Scholar
  4. 4.
    Cote CJ (2005) Pediatric anesthesia. In: Miller RD (ed) Miller’s anesthesia, vol 60, 6th edn. Elsevier Churchill Livingstone, Philadelphia, pp 2367–2407Google Scholar
  5. 5.
    Hillier SC, Krishna G, Brasoveanu E (2004) Neonatal anesthesia. Seminars in Pediatric Surgery 13:142–151PubMedCrossRefGoogle Scholar
  6. 6.
    Drukker A, Guignard JP (2002) Renal aspects of the term and preterm infant: A selective update. Curr Opin Pediatr 14:175–182PubMedCrossRefGoogle Scholar
  7. 7.
    Gow PJ, Ghabrial H, Smallwood RA et al (2001) Neonatal hepatic drug elimination. Pharmacol Toxicol 88:3–15PubMedCrossRefGoogle Scholar
  8. 8.
    Berry FA (1996) Neonatal anesthesia. In: Barash PG, Cullen BF, Stoelting RK (eds) Clin Anesthesia, vol 43, 3rd edn. Lippincott-Raven, Philadelphia, pp 1091–1114Google Scholar
  9. 9.
    Sessler DI (2005) Temperature monitoring. In: Miller RD (ed) Miller’s anesthesia, vol 40, 6th edn. Elsevier Churchill Livingstone, Philadelphia, pp 1571–1597Google Scholar
  10. 10.
    Morgan GE, Mikhail MS, Murray MJ, Larson CP (2002) Pediatric anesthesia: Clin Anesthesiology, vol 44, 3th edn. McGraw-Hill, New York, pp 849–874Google Scholar
  11. 11.
    Rice HE, Caty MG, Glick PL (1998) Fluid therapy for pediatric surgical patient. Pediatr Clin North Am 45:719–727PubMedCrossRefGoogle Scholar
  12. 12.
    Cote CJ, Zaslavsky A, Downes JJ et al (1995) Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis. Anesthesiology 82:809–822PubMedCrossRefGoogle Scholar
  13. 13.
    Kain ZN, Caranico LA, Mayes LC et al (1998) Preoperative preparation programs in children: a comparative examination. Anesth Analg 87:1249–1255PubMedCrossRefGoogle Scholar
  14. 14.
    Nicolson SC, Dorsey AT, Schreiner MS (1992) Shortened preanesthetic fasting interval in pediatric cardiac surgical patients. Anesth Analg 74:694–697PubMedCrossRefGoogle Scholar
  15. 15.
    Fasting S, Soreide E, Raeder JC (1998) Changing preoperative fasting policies. Impact of a national consensus. Anaesthesiol Scand 42:1188–1191Google Scholar
  16. 16.
    Green CR, Pandit SK, Schork MA (1996) Preoperative fasting time: is the traditional policy changing? Results of a national survey. Anesth Analg 83:123–128PubMedCrossRefGoogle Scholar
  17. 17.
    Webster PA, Salassi-Scotter MR (1997) Peripheral vascular access. In: Dieckmann RA, Fiser DH, Selbst SM (eds) Pediatric emergency and critical care procedures, vol 30. Mosby-Year Book, St Louis, pp 187–195Google Scholar
  18. 18.
    Motoyama EK (1990) Endotracheal intubation. In: Motoyama EK, Davis PJ (eds). Anesthesia for infants and children, 5th edn. Mosby Company, St Louis, pp 272–275Google Scholar
  19. 19.
    Hartrey RM, Kestin IG (1995) Movement of oral and nasal tracheal tubes as a result of changes in head and neck position. Anesthesia 50:682–687CrossRefGoogle Scholar
  20. 20.
    Weiss M, Knirsch W, Kretschemer O et al (2006) Tracheal tube-tip displacement in children during headneck movement — a radiological assessment. Br J Anaesth 96:486–491PubMedCrossRefGoogle Scholar
  21. 21.
    Goel S, Lim SL (2003) The intubation depth marker: the confusion of the black line. Paediatr Anaesth 13:579–583PubMedCrossRefGoogle Scholar
  22. 22.
    Weiss M, Gerber AC, Dullenkopf (2005) Appropriate placement of intubation depth marks in a new cuffed paediatric tracheal tube. Br J Anesth 94:80–87Google Scholar
  23. 23.
    Weiss M, Balmer C, Dullenkopf A et al (2005) Intubation depth markings allow an improved positioning of endotracheal tubes in children. Can J of Anesth 52:721–726Google Scholar
  24. 24.
    Lerman J, Burrows FA, Oyston JP et al (1990) The minimum alveolar concentration (MAC) and cardiovascular effects of halothane isoflurane and sevoflurane in newborn swine. Anesthesiology 73:717–721PubMedCrossRefGoogle Scholar
  25. 25.
    Taylor RH, Lerman J (1991) Minimum alveolar concentration of desflurane and hemodynamic responses in neonates, infants and children. Anesthesiology 75:975–979PubMedCrossRefGoogle Scholar
  26. 26.
    Lerman J, Sikich N, Kleinman S, Yentis S (1994) The pharmacology of sevoflurane in adults and children. Anesthesiology 80:814–824PubMedCrossRefGoogle Scholar
  27. 27.
    Walker SM, Haugen RD, Richards A (1997) A comparison of sevoflorane and halothane in paediatric day care surgery. Anest Intense Care 25:643–649Google Scholar
  28. 28.
    Setlock MA, Cotter TP, Rosner D (1993) Latex allergy: Failure of prophylaxis to prevent severe reaction. Anest Analg 76:650–652CrossRefGoogle Scholar
  29. 29.
    Porri F, Pradal M, Lemiere C et al (1997) Association between latex sensitization and repeated latex exposure in children. Anesthesiology 86:599–602PubMedCrossRefGoogle Scholar
  30. 30.
    Bowman RM, McLane DG, Grant JA et al (2001) Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg 34:114–120PubMedCrossRefGoogle Scholar
  31. 31.
    Degenhardt P, Golla S, Wahn F, Niggemann B (2001) Latex allergy in pediatric surgery is dependent on repeated operations in the first year of life. J Pediatr Surg 36:1535–1539PubMedCrossRefGoogle Scholar
  32. 32.
    Cremer R, Diepenbruck UK, Hering F, Holschneider AM (2002) Reduction of latex sensitization in spina bifida patients by a primary prophylaxis programme (five years experience). Eur J Pediatr Surg 12:19–21CrossRefGoogle Scholar
  33. 33.
    Cremer R, Hoppe A, Korsch E et al (1998) Natural rubber latex allergy: prevalence and risk factors in patients with spina bifida compared with atopic children and controls. Eur J Pediatr 157:13–16PubMedCrossRefGoogle Scholar
  34. 34.
    Niggemann B, Kulig M, Bergmann R, Wahn U (1998) Development of latex allergy in children up to 5 years of age — a retrospective analysis of risk factors. Pediatr Allergy Immunal 9:36–39CrossRefGoogle Scholar
  35. 35.
    Liebke C, Niggemann B, Wahn U (1996) Sensitivity and allergy to latex in atopic and non-atopic children. Pediatr Allergy Immunal 7:103–107CrossRefGoogle Scholar
  36. 36.
    Birmingham PK, Dsida RM, Grayhack SS, Han J et al (1996) Do latex precautions in children with myelodysplasia reduce intraoperative allergic reactions? Journal of Pediatric Orthopaedics 16:799–802PubMedCrossRefGoogle Scholar
  37. 37.
    Monaret-Vautrin DA, Laxenaire MC, Bavoux F (1990) Allergic shock to latex and ethylene oxide during surgery for spina bifida. Anesthesiology 73:556–558CrossRefGoogle Scholar
  38. 38.
    Slater JE, Mostello LA (1991) Routine testing for latex allergy in patients with spina bifida is not recommended (letter). Anesthesiology 74:391PubMedCrossRefGoogle Scholar
  39. 39.
    Ellswoth PJ, Merguerian PA, Klein RB, Rozycki AA (1993) Evaluation and risk factors of latex allergy in spina bifida patients: is it preventable? J Urol 150:691–693Google Scholar
  40. 40.
    Slater JE (1993) Latex allergy. Ann Allergy 70:1–2PubMedGoogle Scholar
  41. 41.
    Kelly KJ, Kurup VP, Reijula KE, Fink JN (1994) The diagnosis of natural rubber latex allergy. J Allergy Clin Immunol 93:813–816PubMedCrossRefGoogle Scholar
  42. 42.
    Nieta A, Mazon A, Pamies R et al (2002) Efficacy of latex avoidance for primary prevention of latex sensitization in children with spina bifida. J Pediatr 140:370–372CrossRefGoogle Scholar
  43. 43.
    Slater JE, Mostello LA, Shaer C (1991) Rubber-specific IgE in children with spina bifida. J Urol 146:578–579PubMedGoogle Scholar
  44. 44.
    Kimato H (2004) Latex allergy in infants younger than 1 year. Clin Exp Allergy 34:1910–1915CrossRefGoogle Scholar
  45. 45.
    McKinstry LJ, Fenton WJ, Barrett P (1992) Anaesthesia and the patient with latex allergy. Can J Anaesth 39:587–589PubMedGoogle Scholar
  46. 46.
    Halzman RS (1993) Latex allergy: An emerging operating room problem. Anesth Analg 76:635–641Google Scholar
  47. 47.
    Moore JK, Moore EW, Elliott RA et al (2003) Propofol and halothane versus sevoflorane in paediatric daycase surgery: induction and recovery characteristics. Br J Anaesth 90:461–466PubMedCrossRefGoogle Scholar
  48. 48.
    Holzman RS, Van der Velde ME, Kaus SJ et al (1996) Sevoflorane depresses myocardial contractility less than halothane during induction of anesthesia in children. Anesthesiology 85:1260–1267PubMedCrossRefGoogle Scholar
  49. 49.
    Russel JA, Miller Hance WC, Gregory G et al (2001) The safety and efficacy of sevoflorane anesthesia in infants and children with congenital heart disease. Anesth Analg 92:1152–1158CrossRefGoogle Scholar
  50. 50.
    Hertzag JH, Dalton HJ, Anderson BD et al (2000) Prospective evaluation of propofol anesthesia in the pediatric intensive care unit for elective oncology procedures in ambulatory and hospitalized children. Pediatrics 106:742–747CrossRefGoogle Scholar
  51. 51.
    Wee LH, Moriarty A, Cranstan A, Bagshaw O (1999) Remifentanil infusion for major abdominal surgery in small infants. Paediatr Anaesth 9:415–418PubMedCrossRefGoogle Scholar
  52. 52.
    Prys-Roberts C, Lerman J, Murat I et al (2000) Comparison of remifentanil versus regional anaesthesia in children anaesthetized with isoflurane / nitrous oxide. International remifentanil paediatric anaesthesia study group. Anaesthesia 55:870–876PubMedCrossRefGoogle Scholar
  53. 53.
    Ross AK, Davis PJ, Dear GL et al (2001) Pharmacokinetics of remifentanil in anesthetized pediatric patients undergoing elective surgery or diagnostic procedures. Anest Analg 93:1393–1401CrossRefGoogle Scholar
  54. 54.
    De Souza G, Lewis MC, Ter Riet MF (1997) Severe bradicardia after remifentanil. Anesthesiology 87:1019–1020CrossRefGoogle Scholar
  55. 55.
    Chanavaz C, Tirel O, Wodey E et al (2004) Haemodynamic effects of remifentanil in children with and without intravenous atropine. An echocardiographic study. Br J Anaesth 94:74–79PubMedCrossRefGoogle Scholar
  56. 56.
    Goudsouzian NG, Standaert FG (1986) The infant and the myoneural junction. Anesth Analg 65:1208–1217PubMedCrossRefGoogle Scholar
  57. 57.
    Meakin GH (2001) Recent advances in myorelaxant therapy. Paediatr Anaesth 11:523–531PubMedCrossRefGoogle Scholar
  58. 58.
    Klemola UM, Hiller A (2000) Tracheal intubation after induction of anesthesia in children with propofolremifentanil or propofol-recuronium. Can J Anaesth 47:854–859PubMedCrossRefGoogle Scholar
  59. 59.
    Batra YK, Alquattan AR, Ali SS et al (2004) Assessment of tracheal intubating conditions in children using remifentanil and propofol without muscle relaxant. Pediatric Anesthesia 14:452–456PubMedCrossRefGoogle Scholar
  60. 60.
    Crawford MW, Hayes J, Tan JM (2005) Dose-response of remifentanil for tracheal intubation in infants. Anesth Analg 100:1599–1604PubMedCrossRefGoogle Scholar
  61. 61.
    Kurth CD, LeBard SE (1991) Association of postoperative apnea, airway obstruction, and hypoxemia in former premature infants. Anesthesiology 75:22–26PubMedCrossRefGoogle Scholar
  62. 62.
    Cote CJ, Zaslavsky A, Downes JJ et al (1995) Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis. Anesthesiology 82:809–822PubMedCrossRefGoogle Scholar
  63. 63.
    Welborn LG, Hannallah RS, Luban NLC et al (1991) Anemia and postoperative apnea in former preterm infants. Anesthesiology 74:1003–1006PubMedCrossRefGoogle Scholar
  64. 64.
    Welborn LG, Hannallah RS, Fink R et al (1989) Highdose caffeine suppresses postoperative apnea in former preterm infants. Anesthesiology 71:347–349PubMedCrossRefGoogle Scholar
  65. 65.
    Callahan JM(1997) Pharmacologic Apends, vol 12. In: Dieckmann RA, Fiser DH, Selbst SM (eds) Pediatric emergency and critical care procedures. Mosby Year Book, St Louis, pp 53–67Google Scholar
  66. 66.
    Birmingham PK, Tobin MJ, Honthoin TK et al (1997) 24-hour pharmacokinetics of rectal acetaminophen in children: An old drug with new recommendations. Anesthesiology 87:244–252PubMedCrossRefGoogle Scholar
  67. 67.
    Gunter JB (2002) Benefit and risks of local anesthetics in infants and children. Pediatr Drugs 4:649–672Google Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Nigar Baykan
    • 1
  1. 1.Division of NeuroanesthesiologyAcibadem University School of Medicine Hospital for Neurological SciencesIstanbulTurkey

Personalised recommendations