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

Andrew J. Davidson, Neil S. Morton, Sarah J. Arnup, Jurgen C. De Graaff, Nicola Disma, Davinia E. Withington, Geoff Frawley, Rodney W. Hunt, Pollyanna Hardy, Magda Khotcholava, Britta S. Von Ungern Sternberg, Niall Wilton, Pietro Tuo, Ida Salvo, Gillian Ormond, Robyn Stargatt, Bruno Guido Locatelli, Mary Ellen McCann, Katherine Lee, Suzette Sheppard & 65 others Penelope Hartmann, Philip Ragg, Marie Backstrom, David Costi, Britta S. Von Ungern-Sternberg, Graham Knottenbelt, Giovanni Montobbio, Leila Mameli, Gaia Giribaldi, Alessio Pini Prato, Girolamo Mattioli, Andrea Wolfler, Francesca Izzo, Valter Sonzogni, Jose T D G Van Gool, Sandra C. Numan, Cor J. Kalkman, J. H M Hagenaars, Anthony R. Absalom, Frouckje M. Hoekstra, Martin J. Volkers, Koto Furue, Josee Gaudreault, Charles Berde, Sulpicio Soriano, Vanessa Young, Navil Sethna, Pete Kovatsis, Joseph P. Cravero, David Bellinger, Jacki Marmor, Anne Lynn, Iskra Ivanova, Agnes Hunyady, Shilpa Verma, David Polaner, Joss Thomas, Martin Meuller, Denisa Haret, Peter Szmuk, Jeffery Steiner, Brian Kravitz, Santhanam Suresh, Stephen R. Hays, Andreas H. Taenzer, Lynne G. Maxwell, Robert K. Williams, Graham T. Bell, Liam Dorris, Claire Adey, Oliver Bagshaw, Anthony Chisakuta, Ayman Eissa, Peter Stoddart, Annette Davis, Paul Myles, Andy Wolf, Neil McIntosh, John Carlin, Kate Leslie, Jonathan De Lima, Greg Hammer, David Field, Val Gebski, Dick Tibboel

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods: Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded. Results: Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3%; OR, 0.20; 95% CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) was 2% in both RA and GA arms (OR, 1.17; 95% CI, 0.41 to 3.33; P = 0.7688). The strongest predictor of apnea was prematurity (OR, 21.87; 95% CI, 4.38 to 109.24), and 96% of infants with apnea were premature. Conclusions: RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.

Original languageEnglish (US)
Pages (from-to)38-54
Number of pages17
JournalAnesthesiology
Volume123
Issue number1
DOIs
StatePublished - Jul 20 2015

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Conduction Anesthesia
Spinal Anesthesia
Apnea
General Anesthesia
Randomized Controlled Trials
Odds Ratio
Groin
Herniorrhaphy
Incidence
Postoperative Period
Premature Infants
Anesthesia
Pregnancy

Cite this

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. / Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; De Graaff, Jurgen C.; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; Von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Lee, Katherine; Sheppard, Suzette; Hartmann, Penelope; Ragg, Philip; Backstrom, Marie; Costi, David; Von Ungern-Sternberg, Britta S.; Knottenbelt, Graham; Montobbio, Giovanni; Mameli, Leila; Giribaldi, Gaia; Prato, Alessio Pini; Mattioli, Girolamo; Wolfler, Andrea; Izzo, Francesca; Sonzogni, Valter; Van Gool, Jose T D G; Numan, Sandra C.; Kalkman, Cor J.; Hagenaars, J. H M; Absalom, Anthony R.; Hoekstra, Frouckje M.; Volkers, Martin J.; Furue, Koto; Gaudreault, Josee; Berde, Charles; Soriano, Sulpicio; Young, Vanessa; Sethna, Navil; Kovatsis, Pete; Cravero, Joseph P.; Bellinger, David; Marmor, Jacki; Lynn, Anne; Ivanova, Iskra; Hunyady, Agnes; Verma, Shilpa; Polaner, David; Thomas, Joss; Meuller, Martin; Haret, Denisa; Szmuk, Peter; Steiner, Jeffery; Kravitz, Brian; Suresh, Santhanam; Hays, Stephen R.; Taenzer, Andreas H.; Maxwell, Lynne G.; Williams, Robert K.; Bell, Graham T.; Dorris, Liam; Adey, Claire; Bagshaw, Oliver; Chisakuta, Anthony; Eissa, Ayman; Stoddart, Peter; Davis, Annette; Myles, Paul; Wolf, Andy; McIntosh, Neil; Carlin, John; Leslie, Kate; De Lima, Jonathan; Hammer, Greg; Field, David; Gebski, Val; Tibboel, Dick.

In: Anesthesiology, Vol. 123, No. 1, 20.07.2015, p. 38-54.

Research output: Contribution to journalArticle

Davidson, AJ, Morton, NS, Arnup, SJ, De Graaff, JC, Disma, N, Withington, DE, Frawley, G, Hunt, RW, Hardy, P, Khotcholava, M, Von Ungern Sternberg, BS, Wilton, N, Tuo, P, Salvo, I, Ormond, G, Stargatt, R, Locatelli, BG, McCann, ME, Lee, K, Sheppard, S, Hartmann, P, Ragg, P, Backstrom, M, Costi, D, Von Ungern-Sternberg, BS, Knottenbelt, G, Montobbio, G, Mameli, L, Giribaldi, G, Prato, AP, Mattioli, G, Wolfler, A, Izzo, F, Sonzogni, V, 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, Bellinger, D, Marmor, J, Lynn, A, Ivanova, I, Hunyady, A, Verma, S, Polaner, D, Thomas, J, Meuller, M, Haret, D, Szmuk, P, Steiner, J, Kravitz, B, Suresh, S, Hays, SR, Taenzer, AH, Maxwell, LG, Williams, RK, Bell, GT, Dorris, L, Adey, C, Bagshaw, O, Chisakuta, A, Eissa, A, Stoddart, P, Davis, A, Myles, P, Wolf, A, McIntosh, N, Carlin, J, Leslie, K, De Lima, J, Hammer, G, Field, D, Gebski, V & Tibboel, D 2015, '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, vol. 123, no. 1, pp. 38-54. https://doi.org/10.1097/ALN.0000000000000709
Davidson, Andrew J. ; Morton, Neil S. ; Arnup, Sarah J. ; De Graaff, Jurgen C. ; Disma, Nicola ; Withington, Davinia E. ; Frawley, Geoff ; Hunt, Rodney W. ; Hardy, Pollyanna ; Khotcholava, Magda ; Von Ungern Sternberg, Britta S. ; Wilton, Niall ; Tuo, Pietro ; Salvo, Ida ; Ormond, Gillian ; Stargatt, Robyn ; Locatelli, Bruno Guido ; McCann, Mary Ellen ; Lee, Katherine ; Sheppard, Suzette ; Hartmann, Penelope ; Ragg, Philip ; Backstrom, Marie ; Costi, David ; Von Ungern-Sternberg, Britta S. ; Knottenbelt, Graham ; Montobbio, Giovanni ; Mameli, Leila ; Giribaldi, Gaia ; Prato, Alessio Pini ; Mattioli, Girolamo ; Wolfler, Andrea ; Izzo, Francesca ; Sonzogni, Valter ; Van Gool, Jose T D G ; Numan, Sandra C. ; Kalkman, Cor J. ; Hagenaars, J. H M ; Absalom, Anthony R. ; Hoekstra, Frouckje M. ; Volkers, Martin J. ; Furue, Koto ; Gaudreault, Josee ; Berde, Charles ; Soriano, Sulpicio ; Young, Vanessa ; Sethna, Navil ; Kovatsis, Pete ; Cravero, Joseph P. ; Bellinger, David ; Marmor, Jacki ; Lynn, Anne ; Ivanova, Iskra ; Hunyady, Agnes ; Verma, Shilpa ; Polaner, David ; Thomas, Joss ; Meuller, Martin ; Haret, Denisa ; Szmuk, Peter ; Steiner, Jeffery ; Kravitz, Brian ; Suresh, Santhanam ; Hays, Stephen R. ; Taenzer, Andreas H. ; Maxwell, Lynne G. ; Williams, Robert K. ; Bell, Graham T. ; Dorris, Liam ; Adey, Claire ; Bagshaw, Oliver ; Chisakuta, Anthony ; Eissa, Ayman ; Stoddart, Peter ; Davis, Annette ; Myles, Paul ; Wolf, Andy ; McIntosh, Neil ; Carlin, John ; Leslie, Kate ; De Lima, Jonathan ; Hammer, Greg ; Field, David ; Gebski, Val ; Tibboel, Dick. / 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. In: Anesthesiology. 2015 ; Vol. 123, No. 1. pp. 38-54.
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title = "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",
abstract = "Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods: Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded. Results: Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3{\%} in RA and 4{\%} in GA arms; odds ratio [OR], 0.63; 95{\%} CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3{\%}; OR, 0.20; 95{\%} CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) was 2{\%} in both RA and GA arms (OR, 1.17; 95{\%} CI, 0.41 to 3.33; P = 0.7688). The strongest predictor of apnea was prematurity (OR, 21.87; 95{\%} CI, 4.38 to 109.24), and 96{\%} of infants with apnea were premature. Conclusions: RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.",
author = "Davidson, {Andrew J.} and Morton, {Neil S.} and Arnup, {Sarah J.} and {De Graaff}, {Jurgen C.} and Nicola Disma and Withington, {Davinia E.} and Geoff Frawley and Hunt, {Rodney W.} and Pollyanna Hardy and Magda Khotcholava and {Von Ungern Sternberg}, {Britta S.} and Niall Wilton and Pietro Tuo and Ida Salvo and Gillian Ormond and Robyn Stargatt and Locatelli, {Bruno Guido} and McCann, {Mary Ellen} and Katherine Lee and Suzette Sheppard and Penelope Hartmann and Philip Ragg and Marie Backstrom and David Costi and {Von Ungern-Sternberg}, {Britta S.} and Graham Knottenbelt and Giovanni Montobbio and Leila Mameli and Gaia Giribaldi and Prato, {Alessio Pini} and Girolamo Mattioli and Andrea Wolfler and Francesca Izzo and Valter Sonzogni and {Van Gool}, {Jose T D G} and Numan, {Sandra C.} and Kalkman, {Cor J.} and Hagenaars, {J. H M} and Absalom, {Anthony R.} and Hoekstra, {Frouckje M.} and Volkers, {Martin J.} and Koto Furue and Josee Gaudreault and Charles Berde and Sulpicio Soriano and Vanessa Young and Navil Sethna and Pete Kovatsis and Cravero, {Joseph P.} and David Bellinger and Jacki Marmor and Anne Lynn and Iskra Ivanova and Agnes Hunyady and Shilpa Verma and David Polaner and Joss Thomas and Martin Meuller and Denisa Haret and Peter Szmuk and Jeffery Steiner and Brian Kravitz and Santhanam Suresh and Hays, {Stephen R.} and Taenzer, {Andreas H.} and Maxwell, {Lynne G.} and Williams, {Robert K.} and Bell, {Graham T.} and Liam Dorris and Claire Adey and Oliver Bagshaw and Anthony Chisakuta and Ayman Eissa and Peter Stoddart and Annette Davis and Paul Myles and Andy Wolf and Neil McIntosh and John Carlin and Kate Leslie and {De Lima}, Jonathan and Greg Hammer and David Field and Val Gebski and Dick Tibboel",
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day = "20",
doi = "10.1097/ALN.0000000000000709",
language = "English (US)",
volume = "123",
pages = "38--54",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
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TY - JOUR

T1 - Apnea after Awake Regional and General Anesthesia in Infants

T2 - The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

AU - Davidson, Andrew J.

AU - Morton, Neil S.

AU - Arnup, Sarah J.

AU - De Graaff, Jurgen C.

AU - Disma, Nicola

AU - Withington, Davinia E.

AU - Frawley, Geoff

AU - Hunt, Rodney W.

AU - Hardy, Pollyanna

AU - Khotcholava, Magda

AU - Von Ungern Sternberg, Britta S.

AU - Wilton, Niall

AU - Tuo, Pietro

AU - Salvo, Ida

AU - Ormond, Gillian

AU - Stargatt, Robyn

AU - Locatelli, Bruno Guido

AU - McCann, Mary Ellen

AU - Lee, Katherine

AU - Sheppard, Suzette

AU - Hartmann, Penelope

AU - Ragg, Philip

AU - Backstrom, Marie

AU - Costi, David

AU - Von Ungern-Sternberg, Britta S.

AU - Knottenbelt, Graham

AU - Montobbio, Giovanni

AU - Mameli, Leila

AU - Giribaldi, Gaia

AU - Prato, Alessio Pini

AU - Mattioli, Girolamo

AU - Wolfler, Andrea

AU - Izzo, Francesca

AU - Sonzogni, Valter

AU - Van Gool, Jose T D G

AU - Numan, Sandra C.

AU - Kalkman, Cor J.

AU - Hagenaars, J. H M

AU - Absalom, Anthony R.

AU - Hoekstra, Frouckje M.

AU - Volkers, Martin J.

AU - Furue, Koto

AU - Gaudreault, Josee

AU - Berde, Charles

AU - Soriano, Sulpicio

AU - Young, Vanessa

AU - Sethna, Navil

AU - Kovatsis, Pete

AU - Cravero, Joseph P.

AU - Bellinger, David

AU - Marmor, Jacki

AU - Lynn, Anne

AU - Ivanova, Iskra

AU - Hunyady, Agnes

AU - Verma, Shilpa

AU - Polaner, David

AU - Thomas, Joss

AU - Meuller, Martin

AU - Haret, Denisa

AU - Szmuk, Peter

AU - Steiner, Jeffery

AU - Kravitz, Brian

AU - Suresh, Santhanam

AU - Hays, Stephen R.

AU - Taenzer, Andreas H.

AU - Maxwell, Lynne G.

AU - Williams, Robert K.

AU - Bell, Graham T.

AU - Dorris, Liam

AU - Adey, Claire

AU - Bagshaw, Oliver

AU - Chisakuta, Anthony

AU - Eissa, Ayman

AU - Stoddart, Peter

AU - Davis, Annette

AU - Myles, Paul

AU - Wolf, Andy

AU - McIntosh, Neil

AU - Carlin, John

AU - Leslie, Kate

AU - De Lima, Jonathan

AU - Hammer, Greg

AU - Field, David

AU - Gebski, Val

AU - Tibboel, Dick

PY - 2015/7/20

Y1 - 2015/7/20

N2 - Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods: Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded. Results: Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3%; OR, 0.20; 95% CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) was 2% in both RA and GA arms (OR, 1.17; 95% CI, 0.41 to 3.33; P = 0.7688). The strongest predictor of apnea was prematurity (OR, 21.87; 95% CI, 4.38 to 109.24), and 96% of infants with apnea were premature. Conclusions: RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.

AB - Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods: Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded. Results: Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3%; OR, 0.20; 95% CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) was 2% in both RA and GA arms (OR, 1.17; 95% CI, 0.41 to 3.33; P = 0.7688). The strongest predictor of apnea was prematurity (OR, 21.87; 95% CI, 4.38 to 109.24), and 96% of infants with apnea were premature. Conclusions: RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.

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U2 - 10.1097/ALN.0000000000000709

DO - 10.1097/ALN.0000000000000709

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VL - 123

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EP - 54

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 1

ER -