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Anesthesia-Related Adverse Events in Infants With Gastroschisis at a South African Tertiary Pediatric Hospital: A
Andrew Heald1, Rebecca M Gray2, Marion Arnold3
1Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
Insights
Anesthesia-related adverse events (ARAEs) are common in infants with gastroschisis, especially during surgery. Improving perioperative care in low-resource settings is crucial for better outcomes.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Global Health
Background:
- Infants with gastroschisis face high surgical risks, particularly in low- and middle-income countries (LMICs).
- Survival rates for gastroschisis vary significantly, with higher mortality reported in Sub-Saharan Africa compared to high-income settings.
- Anesthesia-related adverse events (ARAEs) may contribute to poor perioperative outcomes, but data are limited.
Purpose of the Study:
- To determine the incidence and types of ARAEs in infants with gastroschisis.
- To identify risk factors associated with ARAEs in this vulnerable population.
- To evaluate the frequency and safety of general anesthesia for central venous catheter (CVC) procedures.
Main Methods:
- Retrospective cohort study of infants with gastroschisis (2012-2021).
- ARAEs defined using established criteria (APRICOT, NECTARINE).
- Generalized estimating equations (GEE) used to analyze repeated anesthetic exposures.
Main Results:
- 196 general anesthetics administered to 65 infants; 78.5% of patients experienced ARAEs.
- Cardiovascular instability and respiratory complications were the most frequent ARAEs.
- ARAEs were significantly more common during pathology-related surgery (45.7%) than CVC procedures (12.5%).
Conclusions:
- ARAEs are a significant concern in infants with gastroschisis, particularly during non-CVC related surgeries.
- Strategies like optimized fluid management and reduced anesthetic exposure are suggested.
- Enhanced perioperative data systems and prospective studies are needed to improve care pathways in LMICs.
Background:
Infants with gastroschisis represent a high-risk surgical population, particularly in low- and middle-income countries (LMICs) where perioperative resources are constrained. While survival in high-income settings exceeds 90%, reported mortality in Sub-Saharan Africa ranges from 58.1% to 100%. Anesthesia-related adverse events (ARAEs) may contribute to poor perioperative risk, yet data on their incidence and associated factors in this population are limited.
Aims:
To describe the incidence and nature of ARAEs in infants with gastroschisis and identify associated risk factors. A secondary aim was to assess the frequency and safety of general anesthesia administered solely for central venous catheter (CVC) procedures.
Methods:
A retrospective cohort study of all infants with gastroschisis admitted to Red Cross War Memorial Children's Hospital between 2012 and 2021. ARAEs were defined using criteria from APRICOT and NECTARINE studies. Generalized estimating equations (GEE) were used to account for repeated anesthetic exposures per patient.
Results:
Sixty-five infants underwent 196 general anesthetics (median 2 [IQR 1-4] per patient). Sixteen infants underwent 4 or more GAEs for CVC procedures alone. ARAEs occurred in 79 procedures (40.3%), affecting 51 patients (78.5%). Cardiovascular instability was most common, followed by respiratory complications. ARAEs were significantly more frequent during pathology-related surgery than during CVC procedures (45.7% vs. 12.5%; adjusted OR 0.17, 95% CI 0.08 to 0.35, p < 0.001).
Conclusions:
ARAEs are common in infants with gastroschisis, particularly during pathology-related procedures. Potential lessons include careful fluid management, anticipatory extubation planning, and reducing repeated anesthetic exposure. Strengthening perioperative data systems in LMICs and conducting prospective studies are needed to identify modifiable risks and develop safe, context-specific care pathways to improve outcomes for infants with gastroschisis in resource-limited settings.
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