When Is the Ex-Premature Infant No Longer at Risk for Apnea?

Fisher, Dennis M.

doi:10.1097/00000542-199504000-00001

Cited by 31 publications

(15 citation statements)

References 11 publications

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“…2 Gestational age and postconceptional age (PCA) predict the risk of PoA, such that the risk for formerly premature infants is not less than 5% at a PCA of 48 weeks, and not less than 1% at a PCA of 56 weeks. 1 Both central and mixed obstructive apnea are reported: 71% and 21%, respectively. 3 Apneic events occur in both the early and late postoperative course.…”

Section: Résultatsmentioning

confidence: 97%

“…Its incidence varies with the method used to detect apnea, the mode of data recording, the duration of expiration used to define apnea, the patient population, and the anesthetic practice. [1][2][3][4][5][6] In 1982, David Steward 7 first reported apnea in 9% of infants during recovery from anesthesia. A study of infants undergoing pyloromyotomy reported that PoA occurred in 16% of at-risk patients.…”

Section: Résultatsmentioning

confidence: 99%

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Automated respiratory inductive plethysmography to evaluate breathing in infants at risk for postoperative apnea

Brown

Aoude

Galiana

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Although respiratory inductive plethysmography (RIP) is the method of choice for the assessment of sleep disordered breathing, it has not been applied to the study of infants at risk for postoperative apnea (POA). The purpose of this study was to apply RIP to evaluate breathing in these infants. An additional purpose was to implement, simultaneously, three novel algorithms to detect movement artifact, respiratory pauses, and thoracoabdominal asynchrony, since their combined output both detects respiratory pauses and classifies them as obstructive or central in origin. Methods:A prospective study design was employed to record the analogue output of RIP, saturation, and finger plethysmography in a convenience sample of infants. The data record underwent a dual analysis: 1) automated detection of respiratory events; and 2) visual coding of the cardiorespiratory data. A novel index, coined pause density, was calculated as the sum of all respiratory pauses.Results: Twenty infants, whose mean postconceptional ages and weights were 44.47 ± 2.88 weeks and 4.21 ± 0.99 kg, respectively, were recruited. Data recording ranged from four to 24 hr. Ten infants (term = 5) experienced POA: central apnea = 5, mixed obstructive apnea = 6, and two former premature infants experienced both. Twenty-five central apneic events were detected, and the majority followed a sigh. Infants who experienced apnea also had high values of pause density. Conclusion:Respiratory inductive plethysmography may provide a useful method to evaluate breathing in infants at risk for POA. The study of short respiratory pauses may prove useful in predicting apnea risk.

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Section: Résultatsmentioning

confidence: 97%

Section: Résultatsmentioning

confidence: 99%

Automated respiratory inductive plethysmography to evaluate breathing in infants at risk for postoperative apnea

Brown

Aoude

Galiana

et al. 2008

Can J Anesth/J Can Anesth

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“…Fisher in his accompanying editorial also questions "whether a consistent policy regarding postoperative disposition of these patients can be determined based on current information." 42 Although it is known that gestational age, PCA, and anemia are significant predictors of postoperative apnea (grade A), the risks and benefits of an ambulatory procedure should nevertheless be evaluated for each individual patient.…”

Section: What Factors Predict the Occurrence Of Postoperative Apnea?mentioning

confidence: 99%

Patient selection in ambulatory anesthesia — An evidence-based review: part II

et al. 2004

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P Pu ur rp po os se e: : This is the second of two reviews evaluating the management of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: diabetes mellitus; morbid obesity; the ex-premature infant; the child with an upper respiratory infection; malignant hyperthermia; and the use of monoamine oxidase inhibitors.S So ou ur rc ce e: : Medline search strategies and the framework for the evaluation of clinical evidence are presented in Part I. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : Diabetes mellitus has not been linked with adverse events following ambulatory surgery. The morbidly obese patient is at an increased risk for minor respiratory complications in the perioperative period but these events do not increase unanticipated admissions. The ex-premature infant may be considered for ambulatory surgery if post-conceptual age is > 60 weeks and hematocrit is > 30%. The child with a recent upper respiratory tract infection is at an increased risk for perioperative respiratory complications, particularly if endotracheal intubation is required. Patients with malignant hyperthermia may undergo outpatient surgery but require four hours of postoperative temperature monitoring. Sporadic cases of drug interactions have been reported when meperidine and indirectacting catecholamines are administered in the presence of monamine oxidase inhibitors. Ambulatory anesthesia and surgery is safe if these combinations of drugs are avoided.C Co on nc cl lu us si io on n: : Ambulatory anesthesia can be performed in, and is being offered to, a variety of patients with significant coexistent disease. In many cases there is little evidence documenting the outcomes expected in such patients. Prospective observational and interventional trials are required to better define perioperative management. Objectif : C'est la seconde revue qui évalue la prise en charge de patients, dont les pathologies médicales ont été ciblées, qui doivent subir une anesthésie en chirurgie ambulatoire. Les situations choisies comprennent : le diabète, l'obésité morbide, l'enfant né prématurément, l'enfant atteint d'infection des voies respiratoires supérieures, l'hyperthermie maligne et l'usage d'inhibiteurs de la monoamine-oxydase. Source : Les stratégies de recherche dans Medline et le cadre de l'é-valuation de la preuve clinique sont présentés dans la partie I. Constatations principales : Le diabète n'a pas été relié à des événements indésirables à la suite d'une opération ambulatoire. Le patient très obèse est plus à risque de complications respiratoires péri-opératoires mineures, ce qui n'augmente pas les admissions hospitalières imprévues. L'enfant prématuré est admis en chirurgie ambulatoire si l'âge post-conception est > 60 semaines et si l'hématocrite est > 30 %. L'enfant qui a une infection récente des voies respiratoires supérieures

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“…However, general anesthesia increases the risk of 'postoperative apnea' (breath-holding, hypoxemia, bradycardia, or their combinations) in up to 80% of premature and former-premature infants. 1,[7][8][9][10][11] The risk of anesthetic-induced 'postoperative apnea' diminishes markedly between 44 and 60 weeks postconceptional age, 1,7,11,12 but persists longer in older anemic infants. 7 Spinal anesthesia (SA) may reduce the risk of any of the three components of 'postoperative apnea' in this high-risk group.…”

Section: Résultatsmentioning

confidence: 99%

Spinal anesthesia in 62 premature, former-premature or young infants-technical aspects and pitfalls

Shenkman

Hoppenstein

Litmanowitz

et al. 2002

Can J Anesth/J Can Anesth

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Methods:The medical history and perioperative course of all infants who underwent SA over a 28-month period were collected (retrospectively in the first 20).Results: Sixty-two infants underwent surgery under SA. Fifty-five were premature and former-premature, postconceptional age 43.3 ± 5.0 weeks, weight 3261 ± 1243 g. Of these, 21 had co-existing disease: cerebral (six), cardiac (nine), pulmonary (11) and urological (six). Hyperbaric tetracaine or bupivacaine 1 mg·kg -1 with adrenaline was administered. Four infants (three premature) required N 2 O supplementation and three needed general anesthesia. The supplementation rate was similar or lower than in previous studies. Postoperatively, all seven were shown to have lower limb motor and sensory blockade. Complications in premature patients included intraoperative hypoxemia (two), apnea (two) and bradycardia (one). Postoperative complications included bradycardia (three), hypoxemia (one) and apnea and hypoxemia (one). The postoperative complication rate was similar to previous studies.Conclusion: Successful SA in infants depends on close attention to preoperative assessment, appropriate patient positioning during and after lumbar puncture, drug dosing and intra-and postoperative cardiorespiratory monitoring. A relatively high dose of hyperbaric solution of tetracaine or bupivacaine with adrenaline should be administered.

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When Is the Ex-Premature Infant No Longer at Risk for Apnea?

Cited by 31 publications

References 11 publications

Automated respiratory inductive plethysmography to evaluate breathing in infants at risk for postoperative apnea

Automated respiratory inductive plethysmography to evaluate breathing in infants at risk for postoperative apnea

Patient selection in ambulatory anesthesia — An evidence-based review: part II

Spinal anesthesia in 62 premature, former-premature or young infants-technical aspects and pitfalls

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