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Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia

Andrew J Davidson1, Neil S Morton, Sarah J Arnup

  • 1From the Anaesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia (A.J.D., G.F., G.O.); Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Victoria, Australia (A.J.D., G.F.); Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia (A.J.D., G.F., R.W.H.); Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, United Kingdom (N.S.M.); Department of Anaesthesia, Royal Hospital for Sick Children, Glasgow, United Kingdom (N.S.M.); Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia (S.J.A.); Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands (J.C.d.G.); Department of Anesthesia, Istituto Giannina Gaslini, Genoa, Italy (N.D., P.T.); Department of Anaesthesia, Montreal Children's Hospital, Montreal, Quebec, Canada (D.E.W.); Department of Anesthesia, McGill University, Montreal, Quebec, Canada (D.E.W.); Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia (R.W.H.); Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia (R.W.H.); National Perinatal Epidemiology Unit, Clinical Trials Unit, University of Oxford, Oxford, United Kingdom (P.H.); Department of Anaesthesia, Ospedale Papa Giovanni XXIII, Bergamo, Italy (M.K., B.G.L.); Pharmacology, Pharmacy, Anaesthesiology Unit, School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (B.S.v.U.S.); Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Western Australia, Australia (B.S.v.U.S.); Department of Paediatric Anaesthesia and Operating Rooms, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand (N.W.); Department of Anesthesiology and Paedi

Anesthesiology
|May 23, 2015
PubMed

Insights

Regional anesthesia (RA) in infants undergoing inguinal herniorrhaphy reduces early postoperative apnea compared to general anesthesia (GA). Prematurity is the strongest predictor of apnea, necessitating monitoring for ex-premature infants.

Area of Science:

  • Pediatric Anesthesiology
  • Neonatal Surgery
  • Clinical Outcomes Research

Background:

  • Postoperative apnea is a significant complication in young infants undergoing surgery.
  • Regional anesthesia (RA) is proposed to mitigate this risk, but evidence remains limited.
  • General anesthesia (GA) is commonly used, with ongoing research into its long-term neurodevelopmental effects.

Purpose of the Study:

  • To compare the incidence of postoperative apnea between regional anesthesia (RA) and general anesthesia (GA) in infants undergoing inguinal herniorrhaphy.
  • To evaluate the influence of anesthesia type on early and late postoperative apnea.
  • To identify risk factors for postoperative apnea in this patient population.

Main Methods:

  • A randomized controlled trial comparing RA and GA in infants up to 60 weeks postmenstrual age undergoing inguinal herniorrhaphy.
  • Exclusion criteria focused on factors associated with adverse neurodevelopmental outcomes and extreme prematurity (born <26 weeks gestation).
  • The primary outcome was observed apnea within 12 hours postoperatively, with unblinded assessment.

Main Results:

  • The overall incidence of apnea (0-12 hours) was similar between RA (3%) and GA (4%) groups (OR 0.63, P=0.2133).
  • However, early apnea (0-30 minutes) was significantly lower in the RA group (1% vs 3%, OR 0.20, P=0.0367).
  • Prematurity was the strongest predictor of apnea (OR 21.87), with 96% of infants experiencing apnea being premature.

Conclusions:

  • Regional anesthesia (RA) effectively reduces early postoperative apnea in infants undergoing inguinal herniorrhaphy.
  • The study highlights the critical role of prematurity as a risk factor for postoperative apnea.
  • Cardiorespiratory monitoring is recommended for all ex-premature infants following such procedures.
Abstract

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