Journal article
Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes
Anesthesiology (Philadelphia), Vol.123(1), pp.55-65
07/2015
DOI: 10.1097/ALN.0000000000000708
PMCID: PMC4626278
PMID: 26001028
Abstract
Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia study compares neurodevelopmental outcomes after awake RA or GA in otherwise healthy infants. The aim of the study is to describe success and failure rates of RA and report factors associated with failure.
This was a nested cohort study within a prospective, randomized, controlled, observer-blind, equivalence trial. Seven hundred twenty-two infants 60 weeks or less postmenstrual age scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural, or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, were analyzed. Possible predictors of failure were assessed including patient factors, technique, experience of site and anesthetist, and type of local anesthetic.
RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty-four patients required conversion to GA, and an additional 23 patients (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (odds ratio = 2.46).
The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone.
Details
- Title: Subtitle
- Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes
- Creators
- Geoff Frawley - Murdoch Children's Research InstituteGraham BellNicola DismaDavinia E WithingtonJurgen C de GraaffNeil S MortonMary Ellen McCannSarah J ArnupOliver BagshawAndrea WolflerDavid BellingerAndrew J DavidsonGeneral Anesthesia compared to Spinal anesthesia (GAS) Consortium
- Contributors
- Denisa M Haret (Contributor) - University of Iowa, AnesthesiaStephen R Hays (Contributor) - University of Iowa, AnesthesiaSarah S Titler (Contributor) - University of Iowa, Anesthesia
- Resource Type
- Journal article
- Publication Details
- Anesthesiology (Philadelphia), Vol.123(1), pp.55-65
- Publisher
- United States
- DOI
- 10.1097/ALN.0000000000000708
- PMID
- 26001028
- PMCID
- PMC4626278
- ISSN
- 0003-3022
- eISSN
- 1528-1175
- Grant note
- R01 HD061336 / NICHD NIH HHS R01 HD084566 / NICHD NIH HHS 07/01/05 / Department of Health CIHR
- Language
- English
- Date published
- 07/2015
- Academic Unit
- Stead Family Department of Pediatrics; Anesthesia
- Record Identifier
- 9984006461002771
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