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Exploring the Interactions Between Epidural Analgesia, Extubation and Reintubation Outcomes in Infants in Neonatal
Mihaela Visoiu1, Stephanie Parry2, Tyler H Augi3
1Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15261, USA.
Insights
Continuous epidural analgesia may help infants breathe on their own sooner after surgery. However, its exact role in facilitating extubation and the impact of morphine infusions require further investigation.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Neonatal Intensive Care
Background:
- Continuous epidural analgesia is recognized for its potential to improve infant outcomes following surgical procedures.
- The specific impact of epidural analgesia on facilitating extubation in infants remains an area requiring further clarification.
Purpose of the Study:
- To evaluate the contribution of continuous epidural analgesia to facilitating extubation in infants after major surgeries.
- To analyze factors associated with extubation and reintubation timing in this patient population.
Main Methods:
- A retrospective chart review was performed at UPMC Children's Hospital of Pittsburgh.
- Data from 100 infants admitted to the Neonatal Intensive Care Unit (NICU) post-surgery and receiving epidural catheters between 2018 and 2024 were analyzed.
Main Results:
- Of 100 infants, 62 had pulmonary conditions. Extubation occurred in 45 infants in the operating room, while 55 remained intubated post-operatively.
- The median day for extubation was day 2 (IQR 1-4), with 24% remaining intubated beyond day 5.
- Fifteen infants required reintubation, with 8 receiving morphine infusions; morphine use was similar in both extubated and non-extubated groups.
Conclusions:
- Continuous epidural analgesia may play a role in facilitating earlier extubation for some infants undergoing surgery.
- The administration rate of morphine infusions did not differ significantly between infants who were extubated and those who remained intubated, suggesting its role in delayed extubation is unclear.
Background/Objectives:
Continuous epidural analgesia is desirable for improving infant outcomes after surgeries. However, its contribution to facilitating extubation is not well known.
Methods:
A retrospective chart review was conducted at the UPMC Children's Hospital of Pittsburgh to identify all infants who received an epidural catheter between 2018 and 2024 and required postsurgical admission to the Neonatal Intensive Care Unit (NICU). The study examined the timing of extubation and reintubation, along with associated factors, in 100 infants who underwent major surgeries.
Results:
In total, 100 infants, 43 females and 57 males, 40 (38.39-42.07) weeks corrected gestational age, 3 (2.52-3.42) kg received epidural catheters. Sixty-two patients had a pulmonary condition. Of 45 infants extubated in the operating room, 32 received fentanyl intraoperatively, and 16 required a morphine infusion in the NICU. Among 55 infants that remained intubated, 24% underwent a thoracic procedure, 46 received intraoperatively fentanyl, and 21 needed an opioid infusion postoperatively. The extubation day was median (IQR) 2 (1-4), and 24% remained intubated beyond day 5. Twelve infants were intubated preoperatively, and six required prolonged ventilation beyond day 5. Of 15 infants that required reintubation, 8 received a morphine infusion. The medians (IQR) of the average of three pain and sedation scores before reintubation were 1.67 (1-3) and 0 (-1.67-0), respectively.
Conclusions:
Epidural analgesia may facilitate early extubation in some infants undergoing surgeries. Morphine infusion was administered at a similar rate between infants extubated and those who remained intubated, and its role in delaying extubation timing remains unclear.
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