Spinal anaesthesia and monitored conscious sedation for repair of infantile meningomyelocele

Objectives Monitored conscious sedation combined with spinal anaesthesia (MCSS) to repair myelomeningocoele (MM) has received little attention in the literature. It has the potential of rapid postoperative recovery, minimal perioperative morbidity and probable reduced cost of management. The objective of this study was to prospectively analyze the safety and effectiveness of MCSS during repair of MM in infants. Materials and methods This series consists of a prospective study of the clinical features, anaesthetic technique and perioperative outcome of 30 infants who underwent repair of MM under MCSS. The procedure was considered safe and effective if no event occurred during anaesthesia resulting in the procedure being aborted or postoperative complication related to the anaesthetic technique. Results There were 19 males and 11 females. The median age of the patients was 3 months ranging from 2 days to 12 months. The study included patients with lumbar (four patients), lumbosacral (23 patients) and sacral (three patients) MM. None of the cases needed to be converted to general anaesthesia. The mean duration of surgery was 56.4 min (median=55 min; range of 40–85 min). There was no significant perioperative morbidity or mortality. Conclusions The prevailing adverse socioeconomic status, health undermining religious belief, paucity of neurosurgeons/ neuroanaesthetists and inadequate facilities in sub-Saharan Africa delay the presentation and surgical intervention of patients with MM. This technique is useful if the exclusion criteria are adhered to and should be considered as one of the armamentarium in economically challenged environments as it is probably cheaper than general anaesthesia