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Bradycardia during anesthesia in infants. An epidemiologic study

R L Keenan1, J H Shapiro, F R Kane

  • 1Department of Anesthesiology, Medical College of Virginia--Virginia Commonwealth University, Richmond 23298.

Anesthesiology
|May 1, 1994
PubMed

Insights

Bradycardia is more common in infants during anesthesia, leading to significant complications. Pediatric anesthesiologist presence and avoiding prolonged surgery in sicker infants can reduce risks.

Area of Science:

  • Anesthesiology
  • Pediatric Medicine
  • Critical Care

Background:

  • Bradycardia during infant anesthesia is not well-documented.
  • This study aimed to determine its frequency, causes, and associated morbidity in infants compared to older children.

Purpose of the Study:

  • To quantify the incidence of bradycardia in infants (0-1 year) undergoing anesthesia.
  • To identify causes, morbidity, and contributing factors for bradycardia in this age group.
  • To compare bradycardia rates in infants versus older children.

Main Methods:

  • Analysis of 7,979 anesthetic records for noncardiac surgeries in patients aged 0-4 years.
  • Focus on 4,645 anesthetics in infants (0-1 year) with heart rates <100 bpm.
  • Logistic regression used to identify factors influencing bradycardia frequency, including patient and surgical characteristics, and anesthesiologist supervision.

Main Results:

  • Bradycardia occurred in 1.27% of infants, significantly higher than in older children (0.65% at 3 years, 0.16% at 4 years).
  • Primary causes in infants: disease/surgery (35%), inhalation agent dose (35%), hypoxemia (22%).
  • Morbidity included hypotension (30%), asystole/ventricular fibrillation (10%), and death (8%). Higher ASA status and longer surgeries were associated factors. Presence of a pediatric anesthesiologist reduced likelihood by over 50%.

Conclusions:

  • Infants experience higher rates of bradycardia during anesthesia, with considerable associated morbidity.
  • Risk factors include patient's health status, surgery duration, and lack of specialized pediatric anesthesia supervision.
  • Specialized pediatric anesthesia care is associated with a reduced incidence of intraoperative bradycardia in infants.
Abstract

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