Is spinal anaesthesia in young infants really safer and better than general anaesthesia?

PURPOSE OF REVIEW:Concerns regarding the potential neurotoxic effects of general anaesthesia have seen resurgence in awake spinal anaesthesia in neonates and infants. This review includes recently published data from a large prospective randomized controlled trial with view to determining if spinal anaesthesia is safer and better than general anaesthesia in this population. RECENT FINDINGS:Compared with general anaesthesia, spinal anaesthesia results in less haemodynamic instability and fewer early (<30 min) apnoeic episodes in neonates and infants undergoing inguinal herniorraphy; the overall incidence of apnoeas in the first 12 h postoperatively was similar. Neurodevelopmental outcome 2 years postoperatively was similar. An appreciable failure rate for spinal anaesthesia was confirmed. SUMMARY:Spinal anaesthesia represents a suitable alternative to general anaesthesia in neonates and infants undergoing minor surgery avoiding the need for endotracheal intubation and ventilation. Spinal anaesthesia has some advantages but a significant failure rat and has not been demonstrated to improve neurodevelopmental outcome.