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

Abstract

Background Studies of spinal anesthesia in children are limited to a reduced group of high‐risk patients and it remains relatively underused compared with general anesthesia in this age group in most institutions. In our experience, spinal anesthesia appears to be a good alternative to general anesthesia during pyloromyotomy in neonates and infants. Aims The purpose of this study was to retrospectively evaluate respiratory morbidity of spinal anesthesia compared to general anesthesia in infants undergoing pyloromyotomy. Methods The University Hospital of Salamanca used spinal or general anesthesia on infants undergoing pyloromyotomy between 2003 and 2017. The primary outcome assessed was the prevalence of apnea. The second one was the prevalence of oxygen saturation below 95%. An analysis was performed using t test or Mann‐Whitney U test for continuous variables, and Chi‐square for categorical variables. Logistic regression was done to account for differences in demographic and clinical covariates. Results The study sample consisted of 68 infants and neonates undergoing pyloromyotomy (48 with spinal anesthesia and 20 with general anesthesia). There was a significant difference in apneic episodes after surgery between general (number/percentage = 5/20, 25%) and spinal (number/percentage = 0/48, 0%) groups. Absolute risk reduction is 25% (CI 95%: 6%‐44%), P < .001. Conclusion Spinal anesthesia in neonates with hypertrophic pyloric stenosis undergoing pyloromyotomy was a viable alternative to general anesthesia, reducing the respiratory morbidity associated with the latter.

Epidural versus general anesthesia for open pyloromyotomy in infants: A retrospective observational study

“…5 In a recent Pyloric stenosis can result in metabolic alkalosis that favors respiratory depression and this can be amplified by the use of opiods. 20,27 Epidural as well as spinal anesthesia provides the advantage of opioid free or opioid reduced anesthesia.…”

“…However, there are recently upcoming smaller studies that report encouraging data addressing the management of neonates with hypertrophic pyloric stenosis without GA 6,20 . Sanchez‐Conde et al 20 found a significant reduction of apnea and desaturation episodes after spinal anesthesia (SA) under sedation compared to patients with hypertrophic pyloric stenosis managed with GA. These authors presented similar SpO 2 trends for GA and SA compared to our data with higher SpO 2 values seen in patients under SA and sedation 20 .…”

“…Sanchez‐Conde et al 20 found a significant reduction of apnea and desaturation episodes after spinal anesthesia (SA) under sedation compared to patients with hypertrophic pyloric stenosis managed with GA. These authors presented similar SpO 2 trends for GA and SA compared to our data with higher SpO 2 values seen in patients under SA and sedation 20 . We appreciate the work of Sanchez‐Conde and coworkers and sympathize with the views an advantages of a management of hypertrophic pyloric stenosis patients without the use of GA.…”

“…Thus, it is not expected that in the near future large multicenter studies comparing the risks of EA under GA with that of ultrasound controlled EA under sedation will be published. However, there are recently upcoming smaller studies that report encouraging data addressing the management of neonates with hypertrophic pyloric stenosis without GA 6,20. Sanchez-Conde et al20 found a significant reduction of apnea and desaturation episodes after spinal anesthesia (SA) under sedation compared to patients with hypertrophic pyloric stenosis managed with GA.…”

Spinal Anesthesia for Open Gastrostomy in an Infant after Stage I Norwood for Hypoplastic Left Heart

“…When compared to general anesthesia, spinal anesthesia produces fewer hemodynamic changes in infants, eliminates the need for tracheal intubation, oxygen supplementation and mechanical ventilation, thus reducing the incidence of adverse respiratory events. [ 4 ] Spinal anesthesia eliminates the need for another exposure to volatile anesthetics in a group of patients who are already at risk for poorer neurodevelopmental outcomes. Spinal anesthesia also minimizes or eliminates the need for perioperative opioid analgesics.…”