Paediatric spinal anaesthesia: What is new?

Described for the first time in children by August Bier in 1898, spinal anaesthesia still remains largely underused in paediatrics. Despite considerable evidence of its effectiveness and its security, the place of spinal anaesthesia in paediatric population is controversial, and appears limited to specialized centres. The usefulness and benefits of SA in children are well established, in addition to general anaesthesia for major surgery, or as a real alternative for infra umbilical minor surgery and children at high risk of severe per anaesthetics complications. In infants, the decrease in risk of postoperative apnoea and the eviction of all exposures to the potential neurotoxicity of inhaled and systemic anaesthetic agents are strong arguments in favour of spinal anaesthesia. A systematic preclinical assessment of agents administered by intrathecal route in experimental models validated at all stages of development, improve operator training and develop the use of ultrasound remain essential to increase the safety and use of spinal anesthesia in children.