Spinal anesthesia for preterm infants undergoing inguinal hernia repair

Area of Science:

• Pediatric Surgery
• Anesthesiology
• Neonatal Care

Background:

• Inguinal hernia repair (IHR) in preterm infants often necessitates postoperative hospital admission for apnea monitoring.
• General anesthesia is the traditional anesthetic approach for this procedure.
• Preterm infants are at increased risk for postoperative apnea.

Purpose of the Study:

• To evaluate the safety and efficacy of spinal anesthesia for outpatient inguinal hernia repair in preterm infants.
• To determine if spinal anesthesia can eliminate the need for routine postoperative hospital admission for apnea monitoring.
• To compare the postoperative apnea rate in infants receiving spinal anesthesia with historical data from infants receiving general anesthesia.

Main Methods:

• Prospective study of preterm infants (gestational age ≤37 weeks) undergoing IHR with spinal anesthesia between 1982 and 1997.
• Inclusion of high-risk infants (postconceptual age at surgery <60 weeks) with no exclusions for preexisting conditions.
• Calculation and comparison of postoperative apnea rates with published data for general anesthesia.

Main Results:

• Spinal anesthesia was successful in 97.3% of 269 IHR procedures.
• The postoperative apnea rate was 4.9% in infants requiring admission, significantly lower than the 10%-30% rate with general anesthesia (P = .01).
• None of the 103 outpatient cases developed postoperative apnea, with all discharged the same day.

Conclusions:

• Spinal anesthesia is a safe and effective anesthetic technique for outpatient IHR in preterm infants.
• This approach eliminates the need for postoperative hospital admission for apnea monitoring.
• Outpatient IHR with spinal anesthesia leads to considerable cost savings while maintaining quality of care.