Urgent surgical exploration for neonatal torsion under spinal anesthesia
Bridget L. Findlay, MD, Francis A. Jefferson, IV, MD, Patricio C. Gargollo, MD, Dawit Haile, MD, Candace F. Granberg, MD.
Mayo Clinic, Rochester, MN, USA.
BACKGROUND: Neonates are at higher risk for cardiopulmonary and airway complications during general anesthesia. Spinal anesthesia (SA) has been safely used in neonates undergoing urologic surgery. Herein, we report our institution's experience with the use of SA in the urgent surgical treatment of neonatal testicular torsion.
METHODS: We retrospectively reviewed charts of neonates younger than 30 days old undergoing SA for the indication of testicular torsion from May 2018 to June 2022. Patient demographics, adjunctive medications, and time points for start/end of spinal injection, procedure, wheels in/out of operating room (OR) were collected.
RESULTS: Five neonates underwent SA (Figure 1) for scrotal exploration for testicular torsion at an average age of 2.2 days of life. All patients underwent orchidopexy of the unaffected testicle, and three (60%) patients required orchiectomy of the nonviable torsed testicle. Four patients underwent Gomco circumcision following scrotal exploration. Mean patient weight was 3.3kg. Mean operative time was 39.8 minutes, and incision was made 17 minutes after start of spinal injection. One patient received preoperative intranasal dexmedetomidine for sedation. Patients left the operating room 7.8 minutes following closure. There were no reported complications.
CONCLUSIONS: SA was safely utilized in neonates undergoing urgent surgery for testicular torsion, thus eliminating the cardiopulmonary and airway risks of general anesthesia. 
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