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Postoperative respiratory complications in ex-premature infants after inguinal herniorrhaphy
1Department of Surgery, University of Texas, Houston Medical School and the Hermann Children's Hospital, 77030, USA.
Insights
Postoperative cardiorespiratory monitoring for premature infants undergoing inguinal herniorrhaphy is often prolonged. However, this study suggests outpatient surgery is safe and cost-effective, with distress occurring early post-operation.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Anesthesiology
Background:
- The optimal duration for monitoring premature infants post-inguinal herniorrhaphy remains unclear.
- Extended observation periods may lead to unnecessary hospital admissions and increased healthcare costs.
Purpose of the Study:
- To evaluate factors associated with postoperative apnea and bradycardia in premature infants after inguinal herniorrhaphy.
- To determine a safe and appropriate observation period for these patients.
Main Methods:
- Retrospective review of 191 inguinal herniorrhaphies performed between 1993 and 1996.
- Analysis of patient data to identify risk factors for cardiorespiratory events.
Main Results:
- 8.8% of premature infants experienced postoperative apnea or bradycardia requiring reintubation.
- Cardiorespiratory events occurred within 4 hours post-operation.
- Factors such as preoperative apnea, higher American Society of Anesthesia (ASA) scores, and use of intraoperative narcotics and vecuronium were associated with increased risk.
Conclusions:
- Postoperative cardiorespiratory distress in premature infants undergoing inguinal herniorrhaphy is a significant risk.
- Judicious use of narcotics and muscle relaxants, along with careful patient selection (ASA score < 3), may reduce reintubation rates.
- Outpatient inguinal herniorrhaphy is recommended as a safe and cost-effective option due to early onset of potential complications.
Background/Purpose:
The duration of postoperative cardiorespiratory monitoring of premature infants after inguinal herniorrhaphy is uncertain. Prolonged observation requiring hospital admission may be unnecessary and increases costs.
Methods:
This study was a retrospective review of 191 inguinal herniorrhaphies performed between 1993 and 1996 at the Hermann Children's Hospital. The authors reviewed their experience to identify factors associated with postoperative apnea and bradycardia and determine a safe period of observation.
Results:
Among 191 elective inguinal herniorrhaphies performed, 57 (29.8%) were in expremature infants (< or =60 weeks postconception). Five (8.8%) infants either failed extubation or were unable to extubate (group 1). The average age for this group was 41.0 +/- 1.2 weeks compared with 47.2 +/- 1.0 (P = .06) for those who were successfully extubated (group II). Preoperative apnea-bradycardia was found in four (80%) infants in group I compared with 32 (61.5%) in group II (P = 0.67). All group I and 21 (40.4%, P = .09) group II infants with a history of preoperative apnea required intubation for an average of 24.4 +/- 7.8 days and 8.2 +/- 2.4 days, respectively (P = .04). American Society of Anesthesia (ASA) scores were 2.6 +/- 0.4 for group I compared with 1.8 +/- 0.1 for group 11 (P = .01). The use of both intraoperative narcotics (three [60%] in group I v six [12%] in group II, P = .01]) and vecuronium (four [80%] in group I v 16 [31%] in group II, P = .03) were significantly more common in group I infants. Operating room time was 46.4 +/- 4.1 minutes for group I compared with 60.6 +/- 3.9 minutes for group II (P = .27). Postoperative apnea-bradycardia occurred in all five group I infants and two (3.8%, P = .001) group II infants. Group II infants were treated successfully with supplemental oxygen.
Conclusions:
All instances of postoperative apnea-bradycardia and laryngospasm occurred within 4 hours after operation without significant differences between groups. The risk of postoperative cardiorespiratory distress requiring reintubation in premature infants who undergo inguinal herniorrhaphy is not insignificant (8.8%). The judicious use of narcotics and vecuronium, and limiting patient selection to those with ASA score of less than 3 may lessen the need for reintubation. When present cardiorespiratory distress occurs early; therefore we recommend outpatient inguinal herniorrhaphy as a safe and cost-effective choice.