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Adverse Events and Resource Utilization After Spinal and General Anesthesia in Infants Undergoing Pyloromyotomy
Caleb Ing1, Lena S Sun, Alexander F Friend
1From the Departments of *Anesthesiology and †Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY; ‡Department of Anesthesiology, University of Vermont Medical Center, Burlington, VT; §Mailman School of Public Health, Columbia University; and ∥Department of Epidemiology, Columbia University College of Physicians and Surgeons, New York, NY; and ¶Department of Pediatrics, University of Vermont Medical Center, Burlington, VT.
Insights
Spinal anesthesia (SA) for infant pylorotomy showed shorter operating room times and hospital stays compared to general anesthesia (GA). Adverse event rates were similar, but SA reduced exposure to other anesthetics.
Area of Science:
- Pediatric Anesthesiology
- Surgical Outcomes Research
Background:
- Growing concern over long-term effects of general anesthesia (GA) in young children.
- Increasing interest in spinal anesthesia (SA) as an alternative for pediatric procedures.
Purpose of the Study:
- To compare the safety and efficacy of SA versus GA in infants undergoing pyloromyotomy.
- To evaluate adverse events, operating room time, and length of stay associated with each anesthesia technique.
Main Methods:
- Retrospective cohort study comparing infants receiving SA (n=218) versus GA (n=206) for pyloromyotomy between 2000-2013.
- Analysis of adverse events within 48 hours, operating room time, and postoperative length of stay.
- Regression analysis to control for demographic and clinical factors.
Main Results:
- Spinal anesthesia infants experienced significantly shorter operating room times (17.5 minutes faster) and shorter postoperative length of stay (1.19 times longer for GA).
- No significant difference in adverse event rates between SA and GA groups (aOR 0.60; 95% CI 0.27-1.36).
- While 96.3% of SA infants had adequate initial analgesia, 35.8% required supplemental anesthetic agents.
Conclusions:
- Spinal anesthesia for infant pylorotomy is associated with reduced operating room time and length of hospital stay compared to general anesthesia.
- SA did not increase adverse event rates and decreased exposure to intravenous and inhaled anesthetics.
- Long-term benefits of SA require further investigation, including assessment of rare adverse events like aspiration.
Background And Objectives:
Interest in spinal anesthesia (SA) is increasing because of concern about the long-term effects of intravenous (IV) and inhaled anesthetics in young children. This study compared SA versus general anesthesia (GA) in infants undergoing pyloromyotomy.
Methods:
Between 2000 to 2013, the University of Vermont Medical Center almost exclusively used SA for infant pyloromyotomy surgery, whereas Columbia University Medical Center relied on GA. Outcomes included adverse events (AEs) within 48 hours of surgery, operating room (OR) time, and postoperative length of stay (LOS). Regression was used to evaluate the association between anesthesia technique and outcomes, accounting for demographic and clinical covariates.
Results:
We studied 218 infants with SA at the University of Vermont Medical Center and 206 infants with GA at Columbia University Medical Center. In the SA group, 96.3% of infants had adequate initial analgesic levels, but 35.8% required supplemental IV or inhaled anesthetic agents. Compared with GA, the risk of AEs in SA (adjusted odds ratio, 0.60; 95% confidence interval [CI], 0.27-1.36) did not significantly differ, but SA was associated with shorter OR times (17.5 minutes faster; 95% CI, 13.5-21.4 minutes) and shorter postoperative LOS (GA is 1.19 times longer; 95% CI, 1.01-1.40).
Conclusions:
Infants undergoing pyloromyotomy with SA had shorter OR times and postoperative LOS, no significant differences in AE rates, and decreased exposure to IV and inhaled anesthetics, although SA infants often still required supplemental anesthetics. Whether these differences result in any long-term benefit is unclear; further studies are needed to determine the risk of rare AEs, such as aspiration.
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