Urgent surgical exploration for neonatal torsion under spinal anesthesia.
Neonatal torsion
Pediatric regional anesthesia
Pediatric urology
Spinal anesthesia
Journal
Journal of pediatric urology
ISSN: 1873-4898
Titre abrégé: J Pediatr Urol
Pays: England
ID NLM: 101233150
Informations de publication
Date de publication:
29 Aug 2024
29 Aug 2024
Historique:
received:
11
03
2024
revised:
08
08
2024
accepted:
20
08
2024
medline:
8
9
2024
pubmed:
8
9
2024
entrez:
7
9
2024
Statut:
aheadofprint
Résumé
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. We aim to evaluate the safety and efficacy of SA for urgent scrotal exploration in neonates. 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. 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. 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. 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.
Sections du résumé
INTRODUCTION/BACKGROUND
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
OBJECTIVE
We aim to evaluate the safety and efficacy of SA for urgent scrotal exploration in neonates.
STUDY DESIGN
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
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.
DISCUSSION
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.
CONCLUSION
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.
Identifiants
pubmed: 39244432
pii: S1477-5131(24)00444-3
doi: 10.1016/j.jpurol.2024.08.014
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest The authors have no conflicts of interest to disclose.