Major Neonatal Surgery Under Local Anesthesia: A Cohort Study from Bangladesh

Hagander, Lars; Kabir, Mahfuzul; Chowdhury, Zonaid; Gunnarsdottir, Anna; Habib, G; Banu, Tahmina

doi:10.1007/s00268-014-2895-2

Cited by 11 publications

(9 citation statements)

References 61 publications

(71 reference statements)

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“…No studies reported specifics of vital sign changes, but all noted absence of clinical signs of toxicity. The single large included retrospective study reported complications that were surgery (ie, surgical sites infection and wound dehiscence) rather than anesthesia‐related 61 . The mortality rate in this study was attributed to patients’ surgical conditions and comorbidities rather than to the use of local anesthetic; patients receiving local anesthetic actually had lower mortality rate (10.6% vs 11.4%) than another group in the study treated with general anesthesia.…”

Section: Resultsmentioning

confidence: 69%

“…In alphabetical order by author, Table 2 summarizes individual study characteristics for all those included in this review. Most studies pertained to neuraxial procedures 31,32,34‐38,40,44‐58 performed by anesthesiologists, while the majority of peripheral administrations 30,33,39,59‐62 were performed by surgeons. Each of these approaches included instances of single‐dose local anesthesia and catheter placement for continuous infusion.…”

Section: Resultsmentioning

confidence: 99%

“…These limited data are outlined in Table 4, but represent only a small fraction of the patients who received a peripheral local anesthetic treatment. The results of this section were skewed by one large retrospective study that examined 216 patients undergoing major neonatal surgery under local anesthesia in a developing country 61 . Relevant efficacy considerations in this study were time to first feeding and length of hospital stay.…”

Section: Resultsmentioning

confidence: 99%

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Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Relland

Neel

Gehred

et al. 2020

Pediatric Anesthesia

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This review examines the quality and quantity of literature regarding methods that measure efficacy in the context of reported safety of regional anesthesia techniques in preterm and term infants <1 year of age. Because the role of anesthesiologists continues to expand outside the operating room, we focused on all relevant settings with assessments that extend beyond 24 hours from the intraoperative period. All study designs were included from a search of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane databases from 1946 to the end of 2019. A total of 31 studies were included (n = 1038 participants), consisting of five randomized controlled trials and 26 observational studies. Twenty‐three studies examined neuraxial procedures, seven studies examined peripheral procedures, and one study examined both. Efficacy measures included pain assessment tools, analgesic use, and factors pertaining to the recovery of patients. Safety was assessed in multiple systems (neurological, cardiovascular, respiratory, pathological) and with vital signs and/or measures of systemic toxicity. Evidence in this review establishes that neuraxial and peripheral anesthesia treatments may be applied to neonates and infants with a high degree of safety. However, large gaps in the consistency of methods used to assess pain in these studies underline the need for rigorous prospective efficacy studies of these techniques in this population. This systematic review was registered on PROSPERO (CRD42018114466).

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Section: Resultsmentioning

confidence: 69%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Relland

Neel

Gehred

et al. 2020

Pediatric Anesthesia

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“…Hagander et al [7] already demonstrated that even major abdominal surgery can be relatively safely performed under local anaesthesia in premature infants and represents an established option, especially in developing countries where general anaesthesia remains accompanied by significant mortality.…”

Section: Discussionmentioning

confidence: 99%

Bedside placement of ventricular access devices under local anaesthesia in neonates with posthaemorrhagic hydrocephalus: preliminary experience

et al. 2019

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Purpose Posthaemorrhagic ventricular dilatation in preterm infants is primarily treated using temporising measures, of which the placement of a ventricular access device (VAD) is one option. Permanent shunt dependency rates are high, though vary widely. In order to improve the treatment burden and lower shunt dependency rates, we implemented several changes over the years. One of these changes involves the setting of the surgery from general anaesthesia in the OR to local anaesthesia in bed at the neonatal intensive care unit (NICU), which may seem counterintuitive to many. In this article, we describe our surgical technique and present the results of this regimen and compare it to our previous techniques. Methods Retrospective study of a consecutive series of 37 neonates with posthaemorrhagic ventricular dilatation (PHVD) treated using a VAD, with a cohort I (n = 13) treated from 2004 to 2008 under general anaesthesia in the OR, cohort II (n = 11) treated from 2009 to 2013 under general anaesthesia in the NICU and cohort III (n = 13) treated from December 2013 to December 2017 under local anaesthesia on the NICU. Results The overall infection rate was 14%; the VAD revision rate was 22% and did not differ significantly between the cohorts. Procedures under local anaesthesia never required conversion to general anaesthesia and were well tolerated. After an average of 33 tapping days, 38% of the neonates received a permanent ventriculoperitoneal (VP) shunt. The permanent VP shunt rate was 9% with VAD placement under local anaesthesia and 52% when performed under general anaesthesia (p = 0.02). Conclusion Bedside placement of VADs for PHVD under local anaesthesia in neonates is a low-risk, well-tolerated procedure that results in at least equal results to surgery performed under general anaesthesia and/or performed in an OR.

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“…[5,14] Globally, approximately 1.6% of neonates have congenital malformations that can be lethal or disabling if not diagnosed promptly and treated appropriately. [11,[16][17][18] In Cuba, the most common birth defects contributing to infant mortality are congenital cardiopathies, followed by digestive system anomalies, diaphragmatic hernias, chromosomal disorders, and malformations of the central nervous system. [19] About half of the malformations are in the cardiovascular apparatus and of these, about 25% are severe.…”

Section: Introductionmentioning

confidence: 99%

Neonatal Surgery Case Fatality and Associated Factors in a Cuban Pediatric Hospital, 2005–2015

2017

MEDICC Review

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INTRODUCTION Newborns in need of surgery are a challenge to manage and require highly specialized centers with multidisciplinary surgical teams. Since the 1980s, neonatal surgical survival has increased by up to 70% in some countries, mainly due to advances in neonatal intensive care, anesthesia and surgical technique. OBJECTIVE Describe surgical case fatality and survival in a neonatal reference hospital in Cuba, estimate risk of death, and identify potential risk predictors among neonatal characteristics.METHODS A retrospective cohort study was conducted based on hospital administrative data and clinical records for a series of surgical cases in the neonatal intensive care unit of Havana's William Soler University Children's Hospital from January 2005 to December 2015. All neonates who underwent surgery during the study period were included. The dependent variable was discharge status (alive, deceased); independent variables were: sex, age (in days) at time of surgery, gestational age, birth weight, indication for surgery, surgical order (fi rst, repeat), and presence of sepsis or other postoperative complications. The study used contingency tables to analyze associations between neonatal characteristics and discharge status. A classifi cation tree was used to obtain simple estimates of surgical risk.RESULTS Survival was 91.3% (675/739) among 739 neonates who underwent surgery. The majority were male (58.7%, 434/739), full term (84.2%, 622/739), and of normal birth weight (80.6%, 596/739). Most surgeries were performed in the fi rst 10 days of life. Digestive system anomalies constituted the most common surgical indication (57.6%, 426/739); among these anorectal malformations (26.8%, 114/426) and esophageal atresia (17.4%, 74/426) predominated. Survival rates were lower for digestive perforation (57.7%, 15/26), gastroschisis (57.1%, 4/7) and intestinal atresia (73%, 27/37). Neonates in the youngest and oldest age groups at time of surgery faced highest risk of death, especially those in the older group. Term infants with normal birth weight operated on for the fi rst time had survival rates >95%.CONCLUSIONS Survival was high and low birth weight conferred the worst prognosis. Infants with normal birth weight operated on for the fi rst time had the greatest probability of survival.

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Major Neonatal Surgery Under Local Anesthesia: A Cohort Study from Bangladesh

Abstract: Local anesthesia is an established option for the most fragile neonates with major surgical disease. Safe anesthesia ought to be accessible to all children of the world. The global pandemic of perioperative mortality needs to be addressed.

Cited by 11 publications

References 61 publications

Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Bedside placement of ventricular access devices under local anaesthesia in neonates with posthaemorrhagic hydrocephalus: preliminary experience

Neonatal Surgery Case Fatality and Associated Factors in a Cuban Pediatric Hospital, 2005–2015

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