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

• Published in: Pediatric anesthesia 2025-02, Vol.35 (2), p.147-154
• Main Authors: Taverner, Fiona J., Burgoyne, Laura L., Scott‐Weekly, Ross, Griend, Benjamin F., Chooi, Cheryl S. L., Khurana, Sanjeev, Humphreys, Susan R., Lemaqz, Shalem, Morris, Scott, Roberts, Claire T., Ungern‐Sternberg, Britta S.
• Format: Article
• Language: English
• Subjects: Cardiac arrhythmia; caudal; dexmedetomidine; General anesthesia; Hernias; high‐flow; Hypotension; infant; inguinal hernia; Research Report; Surgery
• ISSN: 1155-5645; 1460-9592; 1460-9592
• DOI: 10.1111/pan.15040

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.