Journal article
Differences in Blood Pressure in Infants After General Anesthesia Compared to Awake Regional Anesthesia (GAS Study-A Prospective Randomized Trial)
Anesthesia and analgesia, Vol.125(3), pp.837-845
09/01/2017
DOI: 10.1213/ANE.0000000000001870
PMCID: PMC5576550
PMID: 28489641
Abstract
BACKGROUND: The General Anesthesia compared to Spinal anesthesia (GAS) study is a prospective randomized, controlled, multisite, trial designed to assess the influence of general anesthesia (GA) on neurodevelopment at 5 years of age. A secondary aim obtained from the blood pressure data of the GAS trial is to compare rates of intraoperative hypotension after anesthesia and to identify risk factors for intraoperative hypotension.
METHODS: A total of 722 infants <= 60 weeks postmenstrual age undergoing inguinal herniorrhaphy were randomized to either bupivacaine regional anesthesia (RA) or sevoflurane GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born at <26 weeks of gestation. Moderate hypotension was defined as mean arterial pressure measurement of <35 mm Hg. Any hypotension was defined as mean arterial pressure of <45 mm Hg. Epochs were defined as 5-minute measurement periods. The primary outcome was any measured hypotension <35 mm Hg from start of anesthesia to leaving the operating room. This analysis is reported primarily as intention to treat (ITT) and secondarily as per protocol.
RESULTS: The relative risk of GA compared with RA predicting any measured hypotension of <35 mm Hg from the start of anesthesia to leaving the operating room was 2.8 (confidence interval [CI], 2.0-4.1; P < .001) by ITT analysis and 4.5 (CI, 2.7-7.4, P < .001) as per protocol analysis. In the GA group, 87% and 49%, and in the RA group, 41% and 16%, exhibited any or moderate hypotension by ITT, respectively. In multivariable modeling, group assignment (GA versus RA), weight at the time of surgery, and minimal intraoperative temperature were risk factors for hypotension. Interventions for hypotension occurred more commonly in the GA group compared with the RA group (relative risk, 2.8, 95% CI, 1.7-4.4 by ITT).
CONCLUSIONS: RA reduces the incidence of hypotension and the chance of intervention to treat it compared with sevoflurane anesthesia in young infants undergoing inguinal hernia repair.
Details
- Title: Subtitle
- Differences in Blood Pressure in Infants After General Anesthesia Compared to Awake Regional Anesthesia (GAS Study-A Prospective Randomized Trial)
- Creators
- M. E. McCann - Harvard UniversityD. E. Withington - McGill UniversityS. J. Arnup - Murdoch Children's Research InstituteA. J. Davidson - The University of MelbourneN. Disma - Istituto Giannina GasliniG. Frawley - The University of MelbourneN. S. Morton - McGill UniversityG. Bell - Royal Hospital for ChildrenR. W. Hunt - The University of MelbourneD. C. Bellinger - Harvard UniversityD. M. Polaner - University of DenverA. Leo - Royal Children's HospitalA. R. Absalom - University Medical Center GroningenB. S. von Ungern-Sternberg - Princess Margaret Hospital for ChildrenF. Izzo - Ospedale dei Bambini Vittore BuzziP. Szmuk - Pain Management InstituteV. Young - Harvard UniversityS. G. Soriano - Harvard UniversityJ. C. de Graaff - Pain Management InstituteGAS Consortium
- Contributors
- Sarah Titler (Contributor) - University of Iowa, Anesthesia
- Resource Type
- Journal article
- Publication Details
- Anesthesia and analgesia, Vol.125(3), pp.837-845
- DOI
- 10.1213/ANE.0000000000001870
- PMID
- 28489641
- PMCID
- PMC5576550
- NLM abbreviation
- Anesth Analg
- ISSN
- 0003-2999
- eISSN
- 1526-7598
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 9
- Grant note
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia Department of Paediatric Anaesthesia and Operating Rooms, Starship Children's Hospital, Auckland, New Zealand Department of Anaesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts Department of Anaesthesiology, Children's Hospital Colorado, Denver, Colorado Department of Anaesthesia, Monash Medical Centre, Melbourne, Victoria, Australia Department of Anaesthesia, University of Iowa Hospital, Iowa City, Iowa Department of Pediatric Anaesthesiology, Anne and Robert H. Lurie Children's Memorial Hospital, Chicago, Illinois Department of Anaesthesiology, Children's Medical Center Dallas, Texas Australian and New Zealand College of Anaesthetists, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia Department of Anaesthesia and Pain Medicine, Seattle Children's Hospital, Seattle, Washington National Institutes of Health, Bethesda, Maryland; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Food and Drug Administration, Silver Spring, Maryland Department of Anaesthesiology, Dartmouth-Hitchcock Medical Center, Dartmouth, New Hampshire U54HD090255 / EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) 07/01/05 / National Institute for Health Research; National Institute for Health Research (NIHR) Department of Paediatric Anaesthesia, Women's Children's Hospital, Adelaide, South Australia, Australia Department of Anaesthesia and Pain Management, Princess Margaret Hospital Foundation, Perth, Western Australia, Australia Australian National Health & Medical Research Council, Canberra, Australian Capital Territory, Australia Victorian Government's Operational Infrastructure Support Program in Melbourne, Victoria, Australia
- Language
- English
- Date published
- 09/01/2017
- Academic Unit
- Stead Family Department of Pediatrics; Anesthesia
- Record Identifier
- 9984296132202771
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