Life-threatening Apnea in Infants Recovering from Anesthesia

Spinal anaesthesia for inguinal hernia repair in high-risk neonates

“…Respiratory control mechanisms are often unstable 2 and the risk of apnoeic episodes is aggravated by general anaesthesia. [3][4][5][6] There is a high incidence of inguinal hernias, up to 30% in infants less than 1000 g birth weight. 7 Early surgical correction is required to reduce the risk of incarceration.…”

Spinal anaesthesia for inguinal herniotomy in preterm infants sedated with nitrous oxide: a comparison of lumbar puncture in the lateral or sitting position

“…One patient in the lateral group who had bilateral herniae was given halothane 0.5% in addition to the nitrous oxide in oxygen because of prolonged surgery. The median [range] number of attempts at lumbar puncture was 1 [1][2][3] in the lateral group and 1 [1][2][3] [11][12][13][14][15][16][17][18][19][20][21][22][23] min for unilateral herniae and 38 [30-42] min for bilateral herniae. There were no statistically significant differences in haemodynamic data between the groups before or after spinal block ( Table 2).…”

“…Welborn et al [7] found that the risk of postoperative apnoea increases when intra-operative sedation is given during surgery under spinal anaesthesia in former preterm infants. The need for supplementary general anaesthesia increases the incidence of respiratory complications [3,10]. Although a recently published review article addressed the topic of spinal anaesthesia in neonates and children [11], and another article discussed the positions in which the spinal anaesthetic can be administered [8], there is little published information comparing the effects of the spinal administration of bupivacaine 0.5% in the lateral and sitting positions.…”

“…Inguinal herniae are common in these patients [2]. Although herniotomy is usually considered to be an outpatient surgical procedure, the risk of respiratory depression is high after any form of anaesthesia in premature infants [3,4], a proportion of them requiring mechanical ventilation after general anaesthesia [5]. Previous studies have confirmed the efficacy of spinal anaesthesia for inguinal herniotomy and lower abdominal surgery [4][5][6].…”

Selection of patients for paediatric ambulatory surgery

“…6 In the prospective study by Liu and coworkers, six infants with a history of apnoea and a conceptual age below 46 wk had prolonged apnoea after anaesthesia and surgery. 7 Seven infants who had a preoperative history of apnoea but a conceptual age of 46 to 80 wk did not have apnoea postoperatively. A large number of patients in this study required mechanical ventilation for other, pre-existing conditions (e.g., brain damage), and therefore, the true incidence of apnoea that is precipitated by anaesthesia and surgery in this subgroup remains unknown.…”