Infants undergoing some types of surgery could have better recovery if they receive regional anesthesia rather than general anesthesia, according to two studies published in Anesthesiology,1-2 the official medical journal of the American Society of Anesthesiologists. Researchers explored the differences between the two types of anesthesia by measuring the presence of apnea, a breathing complication, following hernia surgery.
Experts have long examined the effects of anesthesia on infants and toddlers. Many believe infants who undergo general anesthesia in their first year of life might be at higher risk of developmental and learning issues. One option to avoid exposure to the adverse effects of anesthetics is to use regional anesthesia.
“Our research provides the strongest evidence to date on how babies should have anesthesia for hernia repair, the most common procedure among infants,” said Andrew Davidson, MD, study author and associate professor at Royal Children’s Hospital in Melbourne, Australia. “We found that spinal anesthesia is safer than general anesthesia.”
Previous studies suggest that regional anesthesia might reduce the risk of apnea among infants. In the largest study to date, Davidson’s study compared rates of apnea after general or regional anesthesia among 722 infants. It found that while there was little evidence for a difference in late apnea, there was evidence that regional anesthesia reduced the risk of significant apnea in the first 30 minutes after surgery.
Of the 722 infants, Geoff Frawley, MD, physician anesthesiologist and clinical associate professor at Royal Children’s Hospital, examined 339 patients who had spinal anesthesia for factors affecting the failure or success of the anesthetic technique. A failure, by the authors’ definition, was one in which another form of anesthesia had to be used to complete the surgery. Frawley found that 16.8% of cases required an additional form of anesthesia. The research also examined factors that might be associated with failure, including the anesthesia provider’s experience in administering spinal anesthesia.
“Every year millions of children require surgery in their first year of life,” said Frawley. “We aimed to establish which factors are associated with better outcomes when infant spinal anesthesia is used. We found that there is a steep learning curve among anesthesia providers for infant spinal anesthesia, but learning the technique could have a far-reaching impact for infants undergoing surgery.”
The current research is part of an ongoing study to compare the long-term effects of anesthesia on neurodevelopmental outcomes.
- Davidson AJ, Morton NS, Arnup SJ, et al. Apnea after awake regional and general anesthesia in infants: The general anesthesia compared to spinal anesthesia study: Comparing apnea and neurodevelopmental outcomes, A randomized controlled trial. Anesthesiology 2015; doi: 10.1097/ALN.0000000000000709.
- Frawley GP, Bell GT, Disma N, et al. 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 2015; doi: 10.1097/ALN.0000000000000708.