Spinal Anesthesia with Bupivacaine Decreases Cerebral Blood Flow in Former Preterm Infants Marie-Pierre Bonnet, MD, Eric Larousse, MD, Karim Asehnoune, MD, and Dan Benhamou, MD, PhD From the De ´partement d’Anesthe ´sie Re ´animation, Centre Hospitalo-Universitaire de Bice ˆtre, Kremlin Bice ˆtre, France Spinal anesthesia is commonly used in former preterm infants (FPI). In these patients, hypotension induced by spinal anesthesia may impair cerebral blood flow. We measured cerebral blood flow velocity (CBFV) by trans- cranial Doppler ultrasound to assess the effect of hypo- tension induced by spinal anesthesia on cerebral hemo- dynamics. Twelve FPI scheduled for inguinal hernia repair were operated under spinal anesthesia using 1 mg/kg isobaric 0.5% bupivacaine. Systolic, diastolic, and mean middle cerebral artery CBFV were measured at 5 min before and 5 min and 10 min after spinal anes- thesia using a transcranial pulsed Doppler ultrasonog- raphy. Arterial blood pressure and heart rate were re- corded simultaneously. Cerebral arteries resistance index (RI) was calculated as RI = (peak systolic CBFV - end-diastolic CBFV)/peak systolic CBFV. Diastolic CBFV decreased significantly from 30.0  11.1 cm/s to 20.1  8.4 cm/s at 5 min and to 20.1  7.0 cm/s at 10 min. RI increased significantly from 0.7  0.1 to 0.8  0.1 at 5 min and 10 min. Systolic, diastolic, and mean arterial blood pressures decreased significantly at the same time intervals. We suggest that in FPI, spinal an- esthesia induces a decrease in cerebral blood flow re- lated to changes in arterial blood pressure. Whether these changes have deleterious consequences remains to be determined. (Anesth Analg 2004;98:1280 –3) A fter general anesthesia, former preterm infants (FPI) have a significant anesthetic risk, espe- cially for postoperative apnea (1). The probability of apnea is directly related to a weak central respiratory drive and inversely related to the postconceptual age (2). The incidence of postoperative apnea is less frequent after spinal anesthesia compared with general anesthesia (3). Spinal anesthesia is thus commonly used in FPI for surgery of the lower part of the body such as inguinal hernia repair (4). The preganglionic sympathetic block secondary to spinal anesthesia induces a decrease in arterial blood pressure (ABP). Dohi et al. (5) have shown that chil- dren younger than 5 yr of age have better cardiovas- cular stability than adults during spinal anesthesia. This is probably related to their smaller lower extrem- ity blood volume and to a less developed sympathetic nervous system. Several studies have documented that in preterm infants, cerebral blood flow (CBF) autoregulation oc- curs only within a narrow range of mean ABP (6) or is totally absent (7). Consequently, any change in ABP may have a significant impact on CBF. Transcranial Doppler (TCD) ultrasonography, initially described by Aaslid et al. (8), is a noninvasive technique cur- rently used to measure cerebral blood flow velocities (CBFV) and to evaluate CBF. We conducted a prospec- tive cohort study in FPI to assess the effect of spinal anesthesia and related changes in ABP on cerebral hemodynamics evaluated by TCD echosonography. Methods Twelve FPI undergoing unilateral inguinal hernia re- pair were studied prospectively after approval by our ethical committee (CCPPRB, University Hospital Kremlin-Bice ˆtre, France) and parental consent. Pa- tients were consecutively included in the study from May 2002 to October 2002. Inclusion criteria were ASA physical status I–II, gestational age 37 wk, postcon- ceptual age 60 wk. Exclusion criteria were central nervous system disease (intracranial hemorrhage or periventricular leukomalacia), cardiac disease, pulmo- nary sequelae, spinal malformation, and hemostasis disorder. Accepted for publication November 6, 2003. Address correspondence and reprint requests to Dan Benhamou, MD, Department of Anesthesiology and Intensive Care Medicine, CHU de Bice ˆtre 78, Rue du Ge ´ne ´ral Leclerc F-94275 Kremlin Bice ˆtre. Address email to mariepierre.bonnet@9online.fr. DOI: 10.1213/01.ANE.0000108962.37210.69 ©2004 by the International Anesthesia Research Society 1280 Anesth Analg 2004;98:1280–3 0003-2999/04