Cognitive Outcome After Spinal Anesthesia and Surgery During Infancy

Williams, R. K.; Black, Ian H.; Howard, Diantha B.; Adams, David C.; Mathews, Donald M.; Friend, Alexander F.; Meyers, H. W.

doi:10.1213/ane.0000000000000288

Cited by 36 publications

(22 citation statements)

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“…There is evidence that regional anaesthesia techniques, alone, reduce the incidence of post-operative apnoea when compared with general anaesthesia [1]. Concerns about neurotoxicity from general anaesthesia agents in the developing brain have also contributed to the interest in spinal anaesthesia [2]. SDH occurs in 12-25 per 100,000 children.…”

Section: Discussionmentioning

confidence: 99%

Subdural haematoma following infant spinal anaesthesia

et al. 2015

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Subdural haematoma following infant spinal anaesthesia

et al. 2015

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“…[1][2][3][4][5][6][7][8][9][10] Despite this uncertainty, there is mounting concern in the medical community, with some recommending that elective surgery be delayed in children younger than 3 years. 11 Few procedures at this age, however, are purely elective, and in the vast majority of pediatric surgeries, general anesthesia (GA) with inhaled and IV agents is the standard technique.…”

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confidence: 99%

Adverse Events and Resource Utilization After Spinal and General Anesthesia in Infants Undergoing Pyloromyotomy

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et al. 2016

Regional Anesthesia and Pain Medicine

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Background and Objectives Interest in spinal anesthesia (SA) is increasing due to concern about the long-term effects of intravenous and inhaled anesthetics in young children. This study compared SA versus general anesthesia (GA) in infants undergoing pyloromyotomy. Methods Between 2000 to 2013, the University of Vermont Medical Center (UVMMC) almost exclusively used SA for infant pyloromyotomy surgery, while Columbia University Medical Center (CUMC) relied on GA. Outcomes included adverse events (AE) within 48 hours of surgery, operating room (OR) time, and postoperative length of stay (LOS). Regression was used to evaluate the association between anesthesia technique and outcomes, accounting for demographic and clinical covariates. Results We studied 218 infants with SA at UVMMC and 206 infants with GA at CUMC. In the SA group, 96.3% of infants had adequate initial analgesic levels but 35.8% required supplemental IV or inhaled anesthetic agents. Compared with GA, the risk of AEs in SA (adjusted odds ratio [aOR], 0.60; 95% CI, 0.27 – 1.36) did not differ, but SA was associated with shorter OR times (17.5 minutes faster; 95% CI, 13.5 – 21.4 minutes) and shorter postoperative LOS (GA is 1.19 times longer; 95% CI, 1.01 – 1.40). Discussion Infants undergoing pyloromyotomy with SA had shorter OR times and postoperative LOS, no differences in AE rates, and decreased exposure to intravenous and inhaled anesthetics, although SA infants often still required supplemental anesthetics. Whether these differences result in any long-term benefit is unclear; further studies are needed to determine the risk of rare AEs, such as aspiration.

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“…However, in this month’s issue of Anesthesia & Analgesia, Williams and colleagues have attempted to do just that and in so doing provide insight into one of the primary criticisms of the extant clinical literature. 7 …”

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“…7 The authors queried the Vermont Infant Spinal Registry database, a unique database composed of children who have undergone surgery by spinal anesthesia since 1979. They found 265 children who had received a solitary exposure to spinal anesthesia for one of three surgical procedures: circumcision, pyloromyotomy, or inguinal herniorrhaphy.…”

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confidence: 99%