Apneas in Infants with Postconceptional Age bellow 60 Weeks Undergoing Herniorrhaphy
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Published on: July 14, 2023
Mohamad Gharavi-Fard1, Mehryar Taghavi-Gilani1, Samira Kazemi1
1Cardiac Anesthesia Research Center, Imam-Reza Hospital, School of Medicine, Mashhad University of Medical Science , Mashhad, Iran.
Insights
Postoperative apnea occurred in 20.7% of infants under 60 weeks postconceptual age after herniorrhaphy. Risk factors include prematurity and certain medical conditions, necessitating extended monitoring.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Neonatal Care
Background:
- Postoperative apnea is a significant risk for infants undergoing surgery.
- Herniorrhaphy is a common surgical procedure in infants.
Purpose of the Study:
- To determine the incidence of postoperative apnea in infants under 60 weeks postconceptual age after herniorrhaphy.
- To identify factors associated with postoperative apnea in this population.
Main Methods:
- A prospective study of 150 infants under 60 weeks postconceptual age undergoing elective herniorrhaphy.
- General anesthesia with sevoflurane, remifentanil, atracurium, and N2O.
- Postoperative monitoring for 2 hours in recovery and 10 hours in the ward using pulse oximetry and nasal capnography.
Main Results:
- The incidence of postoperative apnea was 20.7% (31/150 infants).
- Associated factors included postconceptional age, birth weight, and history of apnea, oxygen therapy, metabolic diseases, icterus, or cardiac disease.
- Most apnea events (18%) occurred in the recovery room.
Conclusions:
- The 20.7% incidence of postoperative apnea is considerable in infants under 60 weeks PCA undergoing herniorrhaphy.
- Longer surveillance in the recovery room is recommended for high-risk infants.
- Risk factor evaluation should guide decisions for intensive care unit transfer for prolonged monitoring.
Objective:
Postoperative apnea is a major concern in infants undergoing surgery. In this study, we evaluated incidence and related factors for postoperative apnea in infants less than 60 weeks postconceptual age after herniorrhaphy.
Methods:
One-hundred fifty infants with post conceptional age (PCA) less than 60 weeks who underwent elective herniorrhaphy were studied over eight months in 2012. General anesthesia was induced by sevoflurane and maintained by remifentanil, atracurium, and N2O 60%. Postoperatively, they were monitored for two hours in the recovery room and ten hours in the ward using pulse oximetry and nasal capnography.
Findings:
Totally, 31 (20.7%) cases of postoperative apnea were reported. By comparing the patients, factors associated with postoperative apnea included postconceptional age, birth weight, and history of apnea, oxygen therapy, metabolic diseases, icterus, or cardiac disease. Twenty-seven (18%) apnea cases occurred in recovery room in infants with gestational age (GA) of 35.64±2.73 weeks, while only four (2.6%) patients of GA 36.02±2.0 weeks developed delayed apnea).
Conclusion:
In our study, the incidence of postoperative apnea following inguinal herniorrhaphy under general anesthesia in infants younger than 60 weeks PCA was 20.7%, which is considerable. We recommend longer surveillance and monitoring in recovery room for these infants with high-risk of postoperative apnea. This should be followed by evaluation of risk factors to determine the indication for elective intensive care unit transfer for longer-term monitoring of higher-risk patients.
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