Predictors of failure of awake regional anesthesia for neonatal hernia repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study - Comparing apnea and neurodevelopmental outcomes

Journal article

Frawley, Geoff, Bell, Graham, Disma, Nicola, Withington, Davinia E., de Graaff, Jurgen C., Morton, Neil S., McCann, Mary Ellen, Arnup, Sarah J., Bagshaw, Oliver, Wolfler, Andrea, Bellinger, David, Davidson, Andrew J., the General Anesthesia compared to Spinal anesthesia (GAS) Consortium and Hartmann, Penelope*. (2015). Predictors of failure of awake regional anesthesia for neonatal hernia repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study - Comparing apnea and neurodevelopmental outcomes. Anesthesiology. 123(1), pp. 55-65. https://doi.org/10.1097/ALN.0000000000000708
AuthorsFrawley, Geoff, Bell, Graham, Disma, Nicola, Withington, Davinia E., de Graaff, Jurgen C., Morton, Neil S., McCann, Mary Ellen, Arnup, Sarah J., Bagshaw, Oliver, Wolfler, Andrea, Bellinger, David, Davidson, Andrew J., the General Anesthesia compared to Spinal anesthesia (GAS) Consortium and Hartmann, Penelope*
Abstract

Background:
Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia study compares neurodevelopmental outcomes after awake RA or GA in otherwise healthy infants. The aim of the study is to describe success and failure rates of RA and report factors associated with failure.

Methods:
This was a nested cohort study within a prospective, randomized, controlled, observer-blind, equivalence trial. Seven hundred twenty-two infants 60 weeks or less postmenstrual age scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural, or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, were analyzed. Possible predictors of failure were assessed including patient factors, technique, experience of site and anesthetist, and type of local anesthetic.

Results:
RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty-four patients required conversion to GA, and an additional 23 patients (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (odds ratio = 2.46).

Conclusions:
The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone.

Year2015
JournalAnesthesiology
Journal citation123 (1), pp. 55-65
PublisherLippincott Williams & Wilkins
ISSN0003-3022
Digital Object Identifier (DOI)https://doi.org/10.1097/ALN.0000000000000708
Scopus EID2-s2.0-84937484952
Research or scholarlyResearch
Page range55-65
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
OnlineJul 2015
Publication process dates
Accepted11 Jan 2015
Deposited16 Aug 2021
Additional information

*Member of the General Anesthesia compared to Spinal anesthesia (GAS) Consortium

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