Risk factors for spinal anesthesia in preterm infants undergoing inguinal hernia repair

Abstract

Objectives: To investigate the risk factors and incidence of perioperative adverse effects from unsupplemented spinal anesthesia in preterm infants. Times to resumption of oral feeding and to home discharge were also evaluated.Methods: Perioperative data were collected prospectively for all preterm and former preterm infants who underwent inguinal hernia repair with spinal anesthesia at a tertiary medical center. Results:The study group consisted of 144 infants with a median gestational age of 30 weeks, postmenstrual age of 37 weeks, birth weight of 1,420 g, and weight at surgery of 2,140 g. Overall, six (4.2%) infants had intraoperative complications, which included apnea (2/1.4%), bradycardia (2/1.4%), and hypoxemia (4/2.8%). Postoperative complications occurred in 15 (10.4%) infants, mainly hypoxemia (3/2.1%), bradycardia (8/5.5%), and apnea (6/4.1%). Predictive factors of an unfavorable outcome (apnea, resumption of oral feeding > 6 h postoperatively, or discharge > 30 h postoperatively) were bronchopulmonary dysplasia (odds ratio [OR] = 3.2, 95% confidence interval [95%CI] 2.8-5.3; p = 0.01) and periventricular leukomalacia (OR = 2.8, 95%CI 2.1-4.9; p = 0.03). Conclusions:Spinal anesthesia is safe and effective for inguinal hernia repair in preterm infants, with early resumption of oral feeding and short hospitalization. Bronchopulmonary dysplasia and periventricular leukomalacia may pose risks for an unfavorable outcome.J Pediatr (Rio J). 2012;88(3):222-6: Spinal anesthesia, postoperative apnea, oral feeding, hospital discharge, preterm infants. ResumoObjetivos: Investigar os fatores de risco e a incidência de efeitos adversos perioperatórios advindos da raquianestesia não suplementada em recém-nascidos pré-termo. Também foi avaliado o tempo decorrido até o reinício da alimentação oral e até a alta hospitalar. Métodos:Foram coletados prospectivamente os dados perioperatórios de todos os recém-nascidos prematuros e ex-prematuros submetidos a herniorrafia inguinal com raquianestesia em um centro médico terciário.Resultados: O grupo de estudo consistiu em 144 recém-nascidos com uma idade gestacional mediana de 30 semanas, idade concepcional de 37 semanas, peso de nascimento de 1.420 g, e peso de 2.140 g no momento da cirurgia. No total, seis (4,2%) recém-nascidos apresentaram complicações intraoperatórias, que incluíram apneia (2/1,4%), bradicardia (2/1,4%) e hipoxemia (4/2,8%). Complicações pós-operatórias ocorreram em 15 (10,4%) recém-nascidos, principalmente hipoxemia (3/2,1%), bradicardia (8/5,5%) e apneia (6/4,1%). Os fatores preditivos de desfecho desfavorável (apneia, alimentação oral > 6 h de pós-operatório, ou alta > 30 h de pós-operatório) foram displasia broncopulmonar [razão de chances (OR) = 3,2, intervalo de confiança de 95% (IC95%) 2,8-5,3; p = 0,01] e leucomalácia periventricular (OR = 2,8, IC95% 2,1-4,9; p = 0,03). Conclusões:A raquianestesia é segura e eficaz na herniorrafia inguinal em recém-nascidos pré-termo, levando a um reinício precoce da alimentação oral e a um menor período d...

Subarachnoid Block as a Sole Anesthesia for Emergency Surgical Procedures in Two High-risk Former Preterm Infants

“…Previous large series on the use of spinal anesthesia in preterm babies have reported high success rates, low incidence of post-operative pulmonary complications, reduced duration of post-operative fasting, and increased OR turnover rates [6,8]. In both of our cases, there was no post-operative cardiopulmonary complication and one of the babies could be breastfeed in less than an hour following surgery.…”

“…The recommended dose of bupivacaine for SAB in preterm infants ranges from 0.6 to 1 mg/kg [7]. Shenkman et al demonstrated 90% satisfactory SAB in preterm infants using 1 mg/kg bupivacaine as compared to 79% in a study by Frumiento et al who had administered 0.5 mg/kg dose for SAB [6,8]. The use of higher dose had eliminated the need for sedative supplementation in their study [8].…”

Second infant spinal anesthetic: Incidence, dose modification, and adverse events after initial failure

“…12 Although it has been proposed that some patient factors are associated with an increased risk of failure, there are no evidence that specific factors such as age (current or gestational), weight or gender increase the risk of failure. 13,14 The risk of spinal anesthetic failure in this series; however demonstrated a weak link between years of pediatric anesthetic practice and a strong association between ongoing exposure to infant spinal anesthesia of at least five cases per year.…”

Estudio comparativo retrospectivo de la técnica anestésica en la estenosis hipertrófica de píloro. Anestesia general versus regional

“…-se requiere un anestesiólogo pediátrico con experiencia 21. shenkman et al-2011 152 Realizan ae en 149 prematuros con éxito en 144, utilizan bupivacaína o tetracaína hiperbárica más adrenalina a dosis de 1mg/Kg.…”

“…En la posición de sentado el paciente se mueve menos, los espacios intervertebrales son más prominentes y la presión del LCR aumenta, lo que permite una rápida detección de este. utilizamos la posición de sentados porque tenemos más práctica, esta es la posición mayormente utilizada por los distintos autores149,152,161 , aunque también se describe en algunos trabajos la posición lateral para realizar la punción157 .una aguja con estilete debe ser utilizada para evitar el tumor epidermoide intraespinal que es una complicación muy rara; utilizamos aguja 25G Quincke de 30 mm. que son fáciles de insertar también utilizadas por Kachko et al 60 en el 96% de los casos, Shenkman et al 152 y Puncuh et al 150 en el 100%.…”