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Title: | 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. | Authors: | Van Gool J.T.D.G.;Frawley G.;Bell G.;Disma N.;Withington D.E.;De Graaff J.C.;Morton N.S.;McCann M.E.;Arnup S.J.;Bagshaw O.;Wolfler A.;Bellinger D.;Davidson A.J.;Hardy P.;Hunt R.W.;Stargatt R.;Ormond G.;Hartmann P.;Ragg P.;Backstrom M.;Costi D.;Von Ungern-Sternberg B.S.;Wilton N.;Knottenbelt G.;Montobbio G.;Mameli L.;Tuo P.;Giribaldi G.;Prato A.P.;Mattioli G.;Izzo F.;Salvo I.;Sonzogni V.;Locatelli B.G.;Khotcholava M.;Numan S.C.;Kalkman C.J.;Hagenaars J.H.M.;Absalom A.R.;Hoekstra F.M.;Volkers M.J.;Furue K.;Gaudreault J.;Berde C.;Soriano S.;Young V.;Sethna N.;Kovatsis P.;Cravero J.P.;Marmor J.;Lynn A.;Ivanova I.;Hunyady A.;Verma S.;Polaner D.;Thomas J.;Meuller M.;Haret D.;Suresh S.;Hays S.R.;Taenzer A.H.;Maxwell L.G.;Williams R.K.;Bell G.T.;Dorris L.;Adey C.;Chisakuta A.;Eissa A.;Stoddart P.;Davis A. ;Myles P.;Wolf A.;Carlin J.;Leslie K.;De Lima J.;Field D.;Gebski V.;Tibboel D.;Szmuk P.;Steiner J.;Kravitz B. | Institution: | (Frawley, Davidson) Anaesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, VIC, Australia (Frawley, Davidson) Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, VIC, Australia (Frawley, Davidson) Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia (Bell, Morton) Department of Anaesthesia, Royal Hospital for Sick Children, Glasgow, United Kingdom (Disma) Department of Anesthesia, Istituto Giannina Gaslini, Genoa, Italy (Withington) Department of Anaesthesia, Montreal Children's Hospital, Montreal, QC, Canada (Withington) Department of Anesthesia, McGill University, Montreal, QC, Canada (De Graaff) Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands (Morton) Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, United Kingdom (McCann) Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States (Arnup) Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, VIC, Australia (Bagshaw) Department of Anaesthesia, Birmingham Children's Hospital, Birmingham, United Kingdom (Wolfler) Department of Anesthesiology and Paediatric Intensive Care, Ospedale Pediatrico Vittore Buzzi, Milan, Italy (Bellinger) Department of Neurology, Boston Children's Hospital, Boston, MA, United States (Frawley, Davidson) Anaesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Australia (Frawley, Davidson) Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Australia (Frawley, Davidson) Department of Paediatrics, University of Melbourne, Melbourne, Australia (Hardy) National Perinatal Epidemiology Unit, Clinical Trials Unit, University of Oxford, Oxford, United Kingdom (Arnup) Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Australia (Hunt) Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia (Hunt) Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Australia (Hunt) Department of Paediatrics, University of Melbourne, Melbourne, Australia (Stargatt) School of Psychological Science, La Trobe University, Melbourne, Australia (Stargatt) Child Neuropsychology Research Group, Murdoch Childrens Research Institute, Melbourne, Australia (Ormond, Hartmann) Department of Anaesthesia and Pain Management, Murdoch Childrens Research Institute, Melbourne, Australia (Ragg) Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Australia (Backstrom) Department of Anaesthesia, Monash Medical Centre, Melbourne, Australia (Costi) Department of Paediatric Anaesthesia, Women's and Children's Hospital, Adelaide, Australia (Von Ungern-Sternberg) Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Australia (Von Ungern-Sternberg) Pharmacology, Pharmacy and Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia (Wilton, Knottenbelt) Department of Paediatric Anaesthesia and Operating Rooms, Starship Children's Hospital, Auckland, New Zealand (Disma, Montobbio, Mameli, Tuo, Giribaldi) Department of Anesthesia, Istituto Giannina Gaslini, Genoa, Italy (Prato) Department of Pediatric Surgery, Istituto Giannina Gaslini, Genoa, Italy (Mattioli) DINOGMI Department, University of Genoa, Genoa, Italy (Wolfler, Izzo, Salvo) Department of Anesthesiology and Paediatric Intensive Care, Ospedale Pediatrico Vittore Buzzi, Milan, Italy (Sonzogni, Locatelli, Khotcholava) Department of Anaesthesia, Ospedale Papa Giovanni XXIII, Bergamo, Italy (De Graaff, Van Gool, Numan, Kalkman) Department of Anesthesiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands (Hagenaars, Absalom, Hoekstra, Volkers) Department of Anesthesiology, University Medical Center Groningen, Groningen University, Groningen, Netherlands (Withington) Department of Anesthesia, Montreal Children's Hospital, Montreal, Canada (Withington) McGill University, Montreal, Canada (Furue) Departement D'Anesthesie, Centre Hospitalier, Universitaire Sainte-Justine, Montreal, Canada (Gaudreault) Department of Anesthesia, Montreal Children's Hospital, Montreal, Canada (McCann, Berde, Soriano, Young, Sethna, Kovatsis, Cravero) Department of Anesthesiology, Perioperative, and Pain Medicine, Children's Hospital Boston, Boston, MA, United States (Bellinger, Marmor) Department of Neurology, Children's Hospital Boston, Boston, MA, United States (Lynn, Ivanova, Hunyady, Verma) Department of Anesthesia and Pain Medicine, University of Washington, Seattle, WA, United States (Lynn, Ivanova, Hunyady, Verma) Department of Anesthesia and Pain Medicine, Seattle Children's Hospital, Seattle, WA, United States (Polaner) Department of Anesthesiology, Children's Hospital Colorado, Denver, CO, United States (Polaner) Department of Anesthesiology, University of Colorado, Denver, CO, United States (Thomas, Meuller, Haret) Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA, United States (Szmuk, Steiner, Kravitz) Department of Anesthesiology, Children's Medical Center Dallas, Dallas, TX, United States (Szmuk, Steiner, Kravitz) Department of Anesthesiology, University of Texas, Southwestern Medical Center, Dallas, TX, United States (Szmuk, Steiner, Kravitz) Children's Medical Center at Dallas, Outcome Research Consortium, Dallas, TX, United States (Suresh) Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, United States (Hays) Department of Pediatric Anesthesia, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States (Taenzer) Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States (Maxwell) Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, United States (Williams) Department of Anesthesia and Pediatrics, College of Medicine, University of Vermont, Vermont Children's Hospital, Burlington, VT, United States (Morton) Academic Unit of Anaesthesia, Pain, and Critical Care, University of Glasgow, Glasgow, United Kingdom (Morton, Bell) Department of Anaesthesia, Royal Hospital for Sick Children, Glasgow, United Kingdom (Dorris, Adey) Fraser of Allander Unit, Royal Hospital for Sick Children, Glasgow, United Kingdom (Bagshaw) Department of Anaesthesia, Birmingham Children's Hospital, Birmingham, United Kingdom (Chisakuta) Department of Anaesthetics, Royal Belfast Hospital for Sick Children, Belfast, United Kingdom (Eissa) Anaesthetic Department, Sheffield Children's Hospital, Sheffield, United Kingdom (Stoddart) Department of Paediatric Anaesthesia, Bristol Royal Hospital for Children, Bristol, United Kingdom (Davis) Department of Anaesthesia, Pain Relief and Sedation, Alder Hey Childrens' NHS Foundation Trust, Liverpool, United Kingdom | Issue Date: | 28-Jul-2015 | Copyright year: | 2015 | Publisher: | Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org) | Place of publication: | United States | Publication information: | Anesthesiology. 123 (1) (pp 55-65), 2015. Date of Publication: 20 Jul 2015. | Journal: | Anesthesiology | 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. Method(s): 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. Result(s): 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). Conclusion(s): 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.Copyright © 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1097/ALN.0000000000000708 | PubMed URL: | 26001028 [http://www.ncbi.nlm.nih.gov/pubmed/?term=26001028] | ISSN: | 0003-3022 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/40637 | Type: | Article | Subjects: | caudal anesthesia age anesthesist apnea article cohort analysis controlled study *drug treatment failure epidural anesthesia female *general anesthesia gestational age *hernioplasty herniorrhaphy human infant lumbar puncture major clinical study male priority journal prospective study randomized controlled trial *regional anesthesia risk factor *spinal anesthesia *wakefulness *sevoflurane/ct [Clinical Trial] cohort analysis controlled study *drug treatment failure epidural anesthesia female apnea *general anesthesia gestational age *hernioplasty herniorrhaphy anesthesist human infant Article major clinical study male priority journal prospective study randomized controlled trial *regional anesthesia risk factor *spinal anesthesia *wakefulness lumbar puncture caudal anesthesia age |
Type of Clinical Study or Trial: | Randomised controlled trial |
Appears in Collections: | Articles |
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