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

Geoff Frawley, Graham Bell, Nicola Disma, Davinia E. Withington, Jurgen C. De Graaff, Neil S. Morton, Mary Ellen McCann, Sarah J. Arnup, Oliver Bagshaw, Andrea Wolfler, David Bellinger, Andrew J. Davidson, Pollyanna Hardy, Rodney W. Hunt, Robyn Stargatt, Gillian Ormond, Penelope Hartmann, Philip Ragg, Marie Backstrom, David CostiBritta S. Von Ungern-Sternberg, Niall Wilton, Graham Knottenbelt, Giovanni Montobbio, Leila Mameli, Pietro Tuo, Gaia Giribaldi, Alessio Pini Prato, Girolamo Mattioli, Francesca Izzo, Ida Salvo, Valter Sonzogni, Bruno Guido Locatelli, Magda Khotcholava, 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, Jacki Marmor, Anne Lynn, Iskra Ivanova, Agnes Hunyady, Shilpa Verma, David Polaner, Joss Thomas, Martin Meuller, Denisa Haret, Santhanam Suresh, Stephen R. Hays, Andreas H. Taenzer, Lynne G. Maxwell, Robert K. Williams, Graham T. Bell, Liam Dorris, Claire Adey, Anthony Chisakuta, Ayman Eissa, Peter Stoddart, Annette Davis, Paul Myles, Andy Wolf, John Carlin, Kate Leslie, Jonathan De Lima, David Field, Val Gebski, Dick Tibboel, Peter Szmuk, Jeffery Steiner, Brian Kravitz

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


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 languageEnglish (US)
Pages (from-to)55-65
Number of pages11
Issue number1
StatePublished - Jul 20 2015

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


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