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Pediatric Analgesia: Original Articles
Adverse Events and Resource Utilization After Spinal and General Anesthesia in Infants Undergoing Pyloromyotomy
  1. Caleb Ing, MD, MS*,
  2. Lena S. Sun, MD*,†,
  3. Alexander F. Friend, MS‡,
  4. Arthur Roh, BS*,
  5. Susan Lei, MD*,
  6. Howard Andrews, PhD§,
  7. Guohua Li, MD, DrPH*,§∥ and
  8. Robert K. Williams, MD‡,
  1. From the Departments of *Anesthesiology and †Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY; ‡Department of Anesthesiology, University of Vermont Medical Center, Burlington, VT; §Mailman School of Public Health, Columbia University; and ∥Department of Epidemiology, Columbia University College of Physicians and Surgeons, New York, NY; and ¶Department of Pediatrics, University of Vermont Medical Center, Burlington, VT
  1. Address correspondence to: Caleb Ing, MD, MS, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 W 168th St BHN 4-440, New York, NY 10032 (e-mail: ci2119{at}cumc.columbia.edu).

Abstract

Background and Objectives Interest in spinal anesthesia (SA) is increasing because of concern about the long-term effects of intravenous (IV) and inhaled anesthetics in young children. This study compared SA versus general anesthesia (GA) in infants undergoing pyloromyotomy.

Methods Between 2000 to 2013, the University of Vermont Medical Center almost exclusively used SA for infant pyloromyotomy surgery, whereas Columbia University Medical Center relied on GA. Outcomes included adverse events (AEs) within 48 hours of surgery, operating room (OR) time, and postoperative length of stay (LOS). Regression was used to evaluate the association between anesthesia technique and outcomes, accounting for demographic and clinical covariates.

Results We studied 218 infants with SA at the University of Vermont Medical Center and 206 infants with GA at Columbia University Medical Center. In the SA group, 96.3% of infants had adequate initial analgesic levels, but 35.8% required supplemental IV or inhaled anesthetic agents. Compared with GA, the risk of AEs in SA (adjusted odds ratio, 0.60; 95% confidence interval [CI], 0.27–1.36) did not significantly differ, but SA was associated with shorter OR times (17.5 minutes faster; 95% CI, 13.5–21.4 minutes) and shorter postoperative LOS (GA is 1.19 times longer; 95% CI, 1.01–1.40).

Conclusions Infants undergoing pyloromyotomy with SA had shorter OR times and postoperative LOS, no significant differences in AE rates, and decreased exposure to IV and inhaled anesthetics, although SA infants often still required supplemental anesthetics. Whether these differences result in any long-term benefit is unclear; further studies are needed to determine the risk of rare AEs, such as aspiration.

https://doi.org/10.1097/AAP.0000000000000421

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    Footnotes

    • This work is attributed to the Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY.

      This work was supported in part by the Carl Koller Memorial Research grant from the American Society of Regional Anesthesia and Pain Medicine, Pittsburgh, PA. C.H.I. is supported by the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services, under award K08HS022941. This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), US Department of Health and Human Services, through grant UL1-0TR000040.

      This report was presented in part at the American Society of Regional Anesthesia and Pain Medicine 2014 Meeting, Chicago, IL, April 4–6, 2014.

      The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ or the NIH.