Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Inguinal hernia: protrusion of intestinal organs through an open processus vaginalisIncarcerated hernia: content does not slide back into the abdominal cavityStrangulated hernia: vascular supply becomes insufficient ++ Depending on associated morbidity and surgical requirements, neuraxial anesthesia, GETA, LMA, or a mask airway is appropriateA wide variety of regional anesthesia techniques can be used for inguinal hernia repair, either as an anesthetic or for analgesiaCaudal blocks can be used, more often as an adjunct to general anesthesiaIn older patients, ilioinguinal and iliohypogastric nerve blocks can be performed either preoperatively percutaneously or during the procedure by the surgeonSpinal anesthesia for infants:Not demonstrated to reduce risk of postoperative apneaExperienced helper who positions and holds patient, keeps head in neutral position to avoid airway obstructionSkin infiltration with 1% lidocaine22G 1.5-in styletted needle L4/5 or L5/S1One-milliliter syringe with 0.8 mg/kg 1% tetracaine in D5W, may add epinephrine washSlow injection of anesthetic to avoid total spinal, maintain patient horizontal after injection to avoid cephalad spreadAirway obstruction or apnea indicates a total spinal, which requires immediate endotracheal intubation ++ Postoperative apnea in 20–30% of otherwise healthy former preterm infants undergoing inguinal hernia repairRisk of postoperative apnea decreases with the postconceptional age of the infantSpinal anesthesia often chosen for these patients, although not shown to reduce incidence of apnea and bradycardiaAdmit for observation overnight to monitor for apnea:Ex-preemies (patients born at 36 weeks or earlier) <60 weeks postconceptionPatients born full term (37 weeks or later) <45 weeks postconception ++ Laryngospasm may occur during surgical manipulation of the hernia sac, if anesthesia is too lightMost common surgical procedure in childrenHigher incidence in premature babiesOften bilateral, debate about need to explore contralateral sideIn ex-preemies, surgery usually performed prior to discharge from NICULaparoscopic 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] Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.