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

G. Frawley; G. Bell; N. Disma; D.E. Withington; J.C. De Graaff; N.S. Morton; M.E. Mccann; S.J. Arnup; O. Bagshaw; A. Wolfler; D. Bellinger; A.J. Davidson; P. Hardy; R.W. Hunt; R. Stargatt; G. Ormond; P. Hartmann; P. Ragg; M. Backstrom; D. Costi; Britta S von Ungern-Sternberg; N. Wilton; G. Knottenbelt; G. Montobbio; L. Mameli; P. Tuo; G. Giribaldi; A.P. Prato; G. Mattioli; F. Izzo; I. Salvo; V. Sonzogni; B.G. Locatelli; M. Khotcholava; J.T.D.G. Van Gool; S.C. Numan; C.J. Kalkman; J.H.M. Hagenaars; A.R. Absalom; F.M. Hoekstra; M.J. Volkers; K. Furue; J. Gaudreault; C. Berde; S. Soriano; V. Young; N. Sethna; P. Kovatsis; J.P. Cravero; J. Marmor; A. Lynn; I. Ivanova; A. Hunyady; S. Verma; D. Polaner; J. Thomas; M. Meuller; D. Haret; S. Suresh; S.R. Hays; A.H. Taenzer; L.G. Maxwell; R.K. Williams; G.T. Bell; L. Dorris; C. Adey; A. Chisakuta; A. Eissa

doi:10.1097/ALN.0000000000000708

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

G. Frawley, G. Bell, N. Disma, D.E. Withington, J.C. De Graaff, N.S. Morton, M.E. Mccann, S.J. Arnup, O. Bagshaw, A. Wolfler, D. Bellinger, A.J. Davidson, P. Hardy, R.W. Hunt, R. Stargatt, G. Ormond, P. Hartmann, P. Ragg, M. Backstrom, D. CostiBritta S von Ungern-Sternberg, N. Wilton, G. Knottenbelt, G. Montobbio, L. Mameli, P. Tuo, G. Giribaldi, A.P. Prato, G. Mattioli, F. Izzo, I. Salvo, V. Sonzogni, B.G. Locatelli, M. Khotcholava, J.T.D.G. Van Gool, S.C. Numan, C.J. Kalkman, J.H.M. Hagenaars, A.R. Absalom, F.M. Hoekstra, M.J. Volkers, K. Furue, J. Gaudreault, C. Berde, S. Soriano, V. Young, N. Sethna, P. Kovatsis, J.P. Cravero, J. Marmor, A. Lynn, I. Ivanova, A. Hunyady, S. Verma, D. Polaner, J. Thomas, M. Meuller, D. Haret, S. Suresh, S.R. Hays, A.H. Taenzer, L.G. Maxwell, R.K. Williams, G.T. Bell, L. Dorris, C. Adey, A. Chisakuta, A. Eissa

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Abstract

Copyright © 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. 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.

Original language	English
Pages (from-to)	55-65
Journal	Anesthesiology
Volume	123
Issue number	1
DOIs	https://doi.org/10.1097/ALN.0000000000000708
Publication status	Published - 2015

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10.1097/ALN.0000000000000708

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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., ... Eissa, A. (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), 55-65. https://doi.org/10.1097/ALN.0000000000000708

@article{83ccea1a09244659a07c141c2637442f,

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",

abstract = "Copyright {\textcopyright} 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. 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.",

author = "G. Frawley and G. Bell and N. Disma and D.E. Withington and {De Graaff}, J.C. and N.S. Morton and M.E. Mccann and S.J. Arnup and O. Bagshaw and A. Wolfler and D. Bellinger and A.J. Davidson and P. Hardy and R.W. Hunt and R. Stargatt and G. Ormond and P. Hartmann and P. Ragg and M. Backstrom and D. Costi and {von Ungern-Sternberg}, {Britta S} and N. Wilton and G. Knottenbelt and G. Montobbio and L. Mameli and P. Tuo and G. Giribaldi and A.P. Prato and G. Mattioli and F. Izzo and I. Salvo and V. Sonzogni and B.G. Locatelli and M. Khotcholava and {Van Gool}, J.T.D.G. and S.C. Numan and C.J. Kalkman and J.H.M. Hagenaars and A.R. Absalom and F.M. Hoekstra and M.J. Volkers and K. Furue and J. Gaudreault and C. Berde and S. Soriano and V. Young and N. Sethna and P. Kovatsis and J.P. Cravero and J. Marmor and A. Lynn and I. Ivanova and A. Hunyady and S. Verma and D. Polaner and J. Thomas and M. Meuller and D. Haret and S. Suresh and S.R. Hays and A.H. Taenzer and L.G. Maxwell and R.K. Williams and G.T. Bell and L. Dorris and C. Adey and A. Chisakuta and A. Eissa",

year = "2015",

doi = "10.1097/ALN.0000000000000708",

language = "English",

volume = "123",

pages = "55--65",

journal = "Anesthesiology",

issn = "0003-3022",

publisher = "Lippincott Williams & Wilkins",

number = "1",

}

Frawley, G, Bell, G, Disma, N, Withington, DE, De Graaff, JC, Morton, NS, Mccann, ME, Arnup, SJ, Bagshaw, O, Wolfler, A, Bellinger, D, Davidson, AJ, Hardy, P, Hunt, RW, Stargatt, R, Ormond, G, Hartmann, P, Ragg, P, Backstrom, M, Costi, D, von Ungern-Sternberg, BS, Wilton, N, Knottenbelt, G, Montobbio, G, Mameli, L, Tuo, P, Giribaldi, G, Prato, AP, Mattioli, G, Izzo, F, Salvo, I, Sonzogni, V, Locatelli, BG, Khotcholava, M, Van Gool, JTDG, Numan, SC, Kalkman, CJ, Hagenaars, JHM, Absalom, AR, Hoekstra, FM, Volkers, MJ, Furue, K, Gaudreault, J, Berde, C, Soriano, S, Young, V, Sethna, N, Kovatsis, P, Cravero, JP, Marmor, J, Lynn, A, Ivanova, I, Hunyady, A, Verma, S, Polaner, D, Thomas, J, Meuller, M, Haret, D, Suresh, S, Hays, SR, Taenzer, AH, Maxwell, LG, Williams, RK, Bell, GT, Dorris, L, Adey, C, Chisakuta, A & Eissa, A 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, vol. 123, no. 1, pp. 55-65. https://doi.org/10.1097/ALN.0000000000000708

TY - JOUR

T1 - 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

AU - Frawley, G.

AU - Bell, G.

AU - Disma, N.

AU - Withington, D.E.

AU - De Graaff, J.C.

AU - Morton, N.S.

AU - Mccann, M.E.

AU - Arnup, S.J.

AU - Bagshaw, O.

AU - Wolfler, A.

AU - Bellinger, D.

AU - Davidson, A.J.

AU - Hardy, P.

AU - Hunt, R.W.

AU - Stargatt, R.

AU - Ormond, G.

AU - Hartmann, P.

AU - Ragg, P.

AU - Backstrom, M.

AU - Costi, D.

AU - von Ungern-Sternberg, Britta S

AU - Wilton, N.

AU - Knottenbelt, G.

AU - Montobbio, G.

AU - Mameli, L.

AU - Tuo, P.

AU - Giribaldi, G.

AU - Prato, A.P.

AU - Mattioli, G.

AU - Izzo, F.

AU - Salvo, I.

AU - Sonzogni, V.

AU - Locatelli, B.G.

AU - Khotcholava, M.

AU - Van Gool, J.T.D.G.

AU - Numan, S.C.

AU - Kalkman, C.J.

AU - Hagenaars, J.H.M.

AU - Absalom, A.R.

AU - Hoekstra, F.M.

AU - Volkers, M.J.

AU - Furue, K.

AU - Gaudreault, J.

AU - Berde, C.

AU - Soriano, S.

AU - Young, V.

AU - Sethna, N.

AU - Kovatsis, P.

AU - Cravero, J.P.

AU - Marmor, J.

AU - Lynn, A.

AU - Ivanova, I.

AU - Hunyady, A.

AU - Verma, S.

AU - Polaner, D.

AU - Thomas, J.

AU - Meuller, M.

AU - Haret, D.

AU - Suresh, S.

AU - Hays, S.R.

AU - Taenzer, A.H.

AU - Maxwell, L.G.

AU - Williams, R.K.

AU - Bell, G.T.

AU - Dorris, L.

AU - Adey, C.

AU - Chisakuta, A.

AU - Eissa, A.

PY - 2015

Y1 - 2015

N2 - Copyright © 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. 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.

AB - Copyright © 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. 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.

U2 - 10.1097/ALN.0000000000000708

DO - 10.1097/ALN.0000000000000708

M3 - Article

C2 - 26001028

SN - 0003-3022

VL - 123

SP - 55

EP - 65

JO - Anesthesiology

JF - Anesthesiology

IS - 1

ER -

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

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