Differences in intraoperative hemodynamics between spinal and general anesthesia in infants undergoing pyloromyotomy

Abstract

Background Hypotension and bradycardia are known side effects of spinal anesthesia in pregnant women undergoing cesarean section and adults undergoing other surgical procedures. Whether children experience similar hemodynamic changes is unclear. Aims The purpose of this study is to evaluate hemodynamic effects of spinal anesthesia compared to general anesthesia in a cohort of healthy infants. Methods The University of Vermont Medical Center almost exclusively used spinal anesthesia for infant pyloromyotomy surgery between 2008–2013, while Columbia University Medical Center relied on general anesthesia. The primary outcome assessed was the percentage change in intraoperative heart rate and blood pressure (systolic [SBP] and mean [MAP] blood pressure) from baseline. Analysis was performed using t-tests for continuous variables, followed by linear regression to account for differences in demographic and clinical covariates. Results The study sample consisted of 51 infants with spinal anesthesia at the University of Vermont and 52 infants with general anesthesia at Columbia University. The decrease from baseline for mean intraoperative SBP was −8.2 ± 16.8% for SA and −24.2 ± 17.2% for GA (difference between means: 16.2% [95% confidence interval (CI), 9.5–22.9]), while the decrease from baseline for mean intraoperative MAP was −16.3 ± 19.9% for SA and −24.6 ± 19.3% for GA (difference between means: 8.4% [95% CI, 0.8–16]). SA patients also had smaller drops in minimum intraoperative MAP and SBP. These blood pressure differences persisted even after adjusting for covariates. No differences in heart rate were seen between spinal and general anesthesia. Discussion Our findings show that spinal anesthesia performed in healthy infants undergoing pyloromyotomy results in reduced intraoperative blood pressure changes from baseline, significantly higher blood pressure readings, and no increased bradycardia compared to general anesthesia. Further research is needed to assess whether any clinical impact of these hemodynamic differences between spinal and general anesthesia exists.

Spinal anesthesia compared with general anesthesia for neonates with hypertrophic pyloric stenosis. A retrospective study

“…Spinal anesthesia provides adequate anesthetic requirements in the majority of patients. We needed an additional sedation in five infants (10%), in contrast with Ing et al which requires between 31.4% and 35.8%. These differences may be because their sample contains above and infraumbilical surgery.…”

“…10%), in contrast with Ing et al15,24 which requires between 31.4% and 35.8%. These differences may be because their sample contains above and infraumbilical surgery.…”

“…Spinal anesthesia has some advantages like rapid onset, rapid recovery, minimal physiologic modifications, and desirable hemodynamic stability . Sola et al shows a decrease in MAP in both groups (SA and GA) but cerebral oxygen saturation remains stable because of the cerebral autoregulation.…”

“…One of the main advantages of spinal vs general anesthesia in neonates and infants is the high risk of postoperative apnea related specifically to general anesthesia 4. Preterm infants and some term infants undergoing general anesthesia are at risk of respiratory complications in the postoperative period, mainly due to their immature respiratory musculature and central control mechanism 7,15,20. However, the residual effect of muscle relaxants, opioids, and the inhalation agents, as well as the increased sensitivity of upper airway muscles, cannot be excluded as the cause of respiratory complications in the use of GA 18.…”

Combined Spinal and Caudal Epidural Anesthesia for Prolonged Surgical Procedures in Pediatric-Aged Patients: A Report of Two Cases

“…In addition to avoiding potential neurotoxicity, SA provides several advantages over GA. SA provides superior intraoperative hemodynamic stability (decreased hypotension and bradycardia) when compared to GA [14]. Additionally, SA has been shown to lead to more effective blunting of the surgical stress response, lack of a need for airway management or supplemental oxygen, and limited need for parenteral opioids [10].…”