Combined use of neuraxial and general anesthesia during major abdominal procedures in neonates and infants

With the advent of ultrasound and improvements in equipment, the applications of regional anesthesia in the pediatric population have continued to expand. Although frequently used for postoperative analgesia or as a means of avoiding general anesthesia in patients with comorbid conditions, the adjunctive use of regional anesthesia during general anesthesia may effectively decrease the intraoperative requirements for intravenous and volatile agents, thereby providing a more rapid awakening and earlier tracheal extubation. More recently, the limitation of the requirements for volatile and other anesthetic agents may be desirable, given concerns regarding the potential impact of these agents on neurocognitive outcome in neonates and infants. Several authors have demonstrated the potential utility of combining a neuraxial technique (spinal or epidural anesthesia) with general anesthesia in neonates and infants undergoing intraabdominal procedures. We review the literature regarding the combined use of neuraxial and general anesthesia in neonates and infants during major abdominal surgery, discuss its potential applications in this population, and review the techniques of such practice.