Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases

Lambertz, Andreas; Schälte, Gereon; Winter, J.; Röth, A; Busch, Daniel A.; Ulmer, Tom Florian; Steinau, G.; Neumann, Ulf; Klink, Christian D.

doi:10.1007/s00383-014-3590-y

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…In this study all premature patients underwent surgery with the use of general anesthesia. However, the use of spinal anesthesia alone can be advocated in patients with pre-existing diseases and incarceration undergoing inguinal hernia repair [ 18 ]. The costs of preoperative consultation of anaesthesiologist were significantly higher in the elective repair group.…”

Section: Discussionmentioning

confidence: 99%

Emergency repair of inguinal hernia in the premature infant is associated with high direct medical costs

Verhelst

Goede

Kempen

et al. 2015

Hernia

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PurposeInguinal hernia repair is frequently performed in premature infants. Evidence on optimal management and timing of repair, as well as related medical costs is still lacking. The objective of this study was to determine the direct medical costs of inguinal hernia, distinguishing between premature infants who had to undergo an emergency procedure and those who underwent elective inguinal hernia repair.MethodsThis cohort study based on medical records concerned premature infants with inguinal hernia who underwent surgical repair within 3 months after birth in a tertiary academic children’s hospital between January 2010 and December 2013. Two groups were distinguished: patients with incarcerated inguinal hernia requiring emergency repair and patients who underwent elective repair. Real medical costs were calculated by multiplying the volumes of healthcare use with corresponding unit prices. Nonparametric bootstrap techniques were used to derive a 95 % confidence interval (CI) for the difference in mean costs.ResultsA total of 132 premature infants were included in the analysis. Emergency surgery was performed in 29 %. Costs of hospitalization comprised 65 % of all costs. The total direct medical costs amounted to €7418 per premature infant in the emergency repair group versus €4693 in the elective repair group. Multivariate analysis showed a difference in costs of €1183 (95 % CI −1196; 3044) in favor of elective repair after correction for potential risk factors.ConclusionEmergency repair of inguinal hernia in premature infants is more expensive than elective repair, even after correction for multiple confounders. This deserves to be taken into account in the debate on timing of inguinal hernia repair in premature infants.

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Section: Discussionmentioning

confidence: 99%

Emergency repair of inguinal hernia in the premature infant is associated with high direct medical costs

Verhelst

Goede

Kempen

et al. 2015

Hernia

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“…Many papers addressed this issues, and many centers worldwide confirmed its feasibility, with particular regard to inguinal hernia repair, even in urgent cases. 14,15 Furthermore, Williams et al in 2014, reviewing 265 students who underwent RA in infancy, confirmed that RA does not determine detrimental effects over neurodevelopment. 16 Of note, recent evidences even suggest a possible superiority of RA over GA for postoperative management of neonates and infants undergoing inguinal hernia repair.…”

Section: Considerations Regarding Anesthesiamentioning

confidence: 98%

Timing and Management of Inguinal Hernia in the Premature Baby

2017

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Inguinal hernias in children occur with a prevalence ranging from 3 to 5%. The likelihood of a symptomatic patent processus vaginalis is significantly higher in preterms, as reported by most series. As a consequence, inguinal hernia represents the most common condition requiring surgical repair in the neonate and preterm baby. Surgery aims at avoiding and preventing intestinal and gonadal lesions related to incarceration. Nonetheless, hernia repair is technically demanding, with a relatively high risk of complications including recurrence and testicular atrophy. This paper will address some of most debated aspect of inguinal hernia management in preterms babies. The authors will discuss anesthesiological implications, available surgical techniques, optimal timing for surgery, and reasons for possible contralateral groin exploration. The authors will also discuss literature evidences and will propose their own behavior to provide an algorithm for the correct management of neonates and ex-preterms with inguinal hernia.

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“…La mayoría de los estudios han indicado la AE en pacientes de alto riesgo, sobre todo en prematuros y exprematuros antes de la 60 semana postconcepción 82,141,157,161,189,190 muchos con apnea preoperatoria, en pacientes donde hay que evitar los efectos de la anestesia general o IOT como en los niños con estenosis subglóticas, anomalías congénitas 147 , en pacientes para reducir el consumo de opioides iv. evitando sus efectos respiratorios, sobre todo en pacientes con una limitada reserva respiratoria o riesgo de apnea perioperatoria 35,144,191 .…”

Section: Discussionunclassified

“…8. lambertz et al-2014 161 es un estudio retrospectivo en cirugía de hernia inguinal en menores de 6 meses.…”

Section: Craven Et Al-2009 160unclassified

“…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%.…”

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

Gallego¹,

Isabel²

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Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases

Abstract: Spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants, especially in high-risk premature infants and in cases of hernia incarceration.

Cited by 14 publications

References 31 publications

Emergency repair of inguinal hernia in the premature infant is associated with high direct medical costs

Emergency repair of inguinal hernia in the premature infant is associated with high direct medical costs

Timing and Management of Inguinal Hernia in the Premature Baby

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

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