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Impact of supplemental anesthesia in preterm infants undergoing inguinal hernia repair under spinal anesthesia :
Benedikt Hermann Siegler1, Martha Dudek2, Thomas Müller2
1Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany. benedikt.siegler@med.uni-heidelberg.de.
Insights
Spinal anesthesia (SpA) is an alternative for infant inguinal hernia repair (IHR). Supplemental anesthesia during SpA increased risks for respiratory issues and ICU admission, necessitating caution.
Area of Science:
- Pediatric Anesthesiology
- Surgical Outcomes
- Neonatal Care
Background:
- Spinal anesthesia (SpA) is an alternative to general anesthesia for inguinal hernia repair (IHR) in preterm infants.
- Some infants require supplemental anesthesia during SpA for IHR.
- The impact of supplemental anesthesia on perioperative outcomes needs investigation.
Purpose of the Study:
- To determine the frequency of supplemental anesthesia use in preterm infants undergoing IHR.
- To assess the impact of supplemental anesthesia on perioperative care.
- To evaluate adverse respiratory and hemodynamic events associated with supplemental anesthesia.
Main Methods:
- Retrospective study of preterm infants undergoing IHR.
- Data collected from Heidelberg University Hospital (2009-2018).
- Analysis of 230 patients (255 surgeries) comparing SpA alone versus SpA with supplemental anesthesia.
Main Results:
- 24 out of 189 SpA procedures required supplemental anesthesia.
- Supplemental anesthesia was linked to increased postoperative oxygen use and ICU admissions.
- Perioperative apnea occurred in 2.7% of cases, exclusively after supplemental anesthesia.
- Bilateral IHR and longer surgery duration predicted the need for supplemental anesthesia.
Conclusions:
- While SpA may be favorable for IHR, supplemental anesthesia requires caution.
- Supplemental anesthesia is associated with increased risk of adverse respiratory events.
- Careful monitoring is advised for infants receiving supplemental anesthesia during SpA for IHR.
Background:
In preterm infants, spinal anesthesia (SpA) is recognized as an alternative to general anesthesia for inguinal hernia repair (IHR); however, some patients require supplemental anesthesia during surgery. The purpose of this study was to investigate the frequency and impact of supplemental anesthesia on perioperative care and adverse respiratory and hemodynamic events.
Methods:
A retrospective study of preterm infants undergoing IHR at Heidelberg University Hospital within the first year of life between 2009 and 2018 was carried out.
Results:
In total, 230 patients (255 surgeries) were investigated. Among 189 procedures completed using SpA 24 patients received supplemental anesthesia. Reasons for supplemental anesthesia included loss of anesthetic effect, returning motor response, and respiratory complications. Compared to SpA alone, no differences were found concerning hemodynamic parameters; however, patients requiring supplemental anesthesia displayed higher rates of postoperative oxygen supplementation and unexpected admission to the intensive care unit. The rate of perioperative apnea was 2.7%. Apneic events exclusively occurred after supplemental anesthesia. Bilateral IHR and duration of surgery were associated with the need for supplemental anesthesia.
Conclusion:
Whereas SpA might be favorable when compared to general anesthesia for IHR, the data indicate that particular caution is required in patients receiving supplemental anesthesia due to the possible risk for adverse respiratory events.
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