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  • Inguinal hernia: protrusion of intestinal organs through an open processus vaginalis
  • Incarcerated hernia: content does not slide back into the abdominal cavity
  • Strangulated hernia: vascular supply becomes insufficient

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  • Depending on associated morbidity and surgical requirements, neuraxial anesthesia, GETA, LMA, or a mask airway is appropriate
  • A wide variety of regional anesthesia techniques can be used for inguinal hernia repair, either as an anesthetic or for analgesia
    • Caudal blocks can be used, more often as an adjunct to general anesthesia
    • In older patients, ilioinguinal and iliohypogastric nerve blocks can be performed either preoperatively percutaneously or during the procedure by the surgeon
  • Spinal anesthesia for infants:
    • Not demonstrated to reduce risk of postoperative apnea
    • Experienced helper who positions and holds patient, keeps head in neutral position to avoid airway obstruction
    • Skin infiltration with 1% lidocaine
    • 22G 1.5-in styletted needle L4/5 or L5/S1
    • One-milliliter syringe with 0.8 mg/kg 1% tetracaine in D5W, may add epinephrine wash
    • Slow injection of anesthetic to avoid total spinal, maintain patient horizontal after injection to avoid cephalad spread
    • Airway obstruction or apnea indicates a total spinal, which requires immediate endotracheal intubation

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  • Postoperative apnea in 20–30% of otherwise healthy former preterm infants undergoing inguinal hernia repair
  • Risk of postoperative apnea decreases with the postconceptional age of the infant
  • Spinal anesthesia often chosen for these patients, although not shown to reduce incidence of apnea and bradycardia
  • Admit for observation overnight to monitor for apnea:
    • Ex-preemies (patients born at 36 weeks or earlier) <60 weeks postconception
    • Patients born full term (37 weeks or later) <45 weeks postconception

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  • Laryngospasm may occur during surgical manipulation of the hernia sac, if anesthesia is too light
  • Most common surgical procedure in children
  • Higher incidence in premature babies
  • Often bilateral, debate about need to explore contralateral side
  • In ex-preemies, surgery usually performed prior to discharge from NICU
  • Laparoscopic inguinal hernia repair usually requires endotracheal intubation. However, a brief insertion of a laparoscopic camera in the contralateral hernia sac after an open repair of the other side does not require a change in the anesthetic technique

1. Welborn LG, Rice LJ, Hannallah RS, et al. Postoperative apnea in former preterm infants: prospective comparison of spinal and general anesthesia. Anesthesiology. 1990 May;72:838–842.   [PubMed: 2187377]
2. Craven PD, Badawi N, Henderson-Smart DJ, O’Brien M. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy. Cochrane Database Syst Rev. 2003;3(3):CD003669.   [PubMed: 12917979]
3. Sims C, Johnson CM. Postoperative apnoea in infants. Anaesth Intensive Care. 1994 Feb;22:40–45.   [PubMed: 8160948]
4. Lau ST, Lee YH, Caty MG. Current management of hernias and hydroceles. Semin Pediatr Surg. 2007 Feb;16:50–57.   [PubMed: 17210483]
5. Kumar VH, Clive J, Rosenkrantz TS, Bourque MD, Hussain N. Inguinal hernia in preterm infants (< or = 32-week gestation). Pediatr Surg Int. 2002 Mar;18:147–152.   [PubMed: 11956782]

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