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 Costi & 61 others Britta 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 journalArticle

17 Citations (Scopus)

Abstract

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
JournalAnesthesiology
Volume123
Issue number1
DOIs
StatePublished - Jul 20 2015

Fingerprint

Conduction Anesthesia
Spinal Anesthesia
Herniorrhaphy
Apnea
General Anesthesia
Anesthetics
Caudal Anesthesia
Spinal Puncture
Local Anesthetics
Cohort Studies
Anesthesia
Odds Ratio
Incidence

Cite this

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

In: Anesthesiology, Vol. 123, No. 1, 20.07.2015, p. 55-65.

Research output: Contribution to journalArticle

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, Stoddart, P, Davis, A, Myles, P, Wolf, A, Carlin, J, Leslie, K, De Lima, J, Field, D, Gebski, V, Tibboel, D, Szmuk, P, Steiner, J & Kravitz, B 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
Frawley, Geoff ; Bell, Graham ; Disma, Nicola ; Withington, Davinia E. ; De Graaff, Jurgen C. ; Morton, Neil S. ; McCann, Mary Ellen ; Arnup, Sarah J. ; Bagshaw, Oliver ; Wolfler, Andrea ; Bellinger, David ; Davidson, Andrew J. ; Hardy, Pollyanna ; Hunt, Rodney W. ; Stargatt, Robyn ; Ormond, Gillian ; Hartmann, Penelope ; Ragg, Philip ; Backstrom, Marie ; Costi, David ; Von Ungern-Sternberg, Britta S. ; Wilton, Niall ; Knottenbelt, Graham ; Montobbio, Giovanni ; Mameli, Leila ; Tuo, Pietro ; Giribaldi, Gaia ; Prato, Alessio Pini ; Mattioli, Girolamo ; Izzo, Francesca ; Salvo, Ida ; Sonzogni, Valter ; Locatelli, Bruno Guido ; Khotcholava, Magda ; 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. ; Marmor, Jacki ; Lynn, Anne ; Ivanova, Iskra ; Hunyady, Agnes ; Verma, Shilpa ; Polaner, David ; Thomas, Joss ; Meuller, Martin ; Haret, Denisa ; Suresh, Santhanam ; Hays, Stephen R. ; Taenzer, Andreas H. ; Maxwell, Lynne G. ; Williams, Robert K. ; Bell, Graham T. ; Dorris, Liam ; Adey, Claire ; Chisakuta, Anthony ; Eissa, Ayman ; Stoddart, Peter ; Davis, Annette ; Myles, Paul ; Wolf, Andy ; Carlin, John ; Leslie, Kate ; De Lima, Jonathan ; Field, David ; Gebski, Val ; Tibboel, Dick ; Szmuk, Peter ; Steiner, Jeffery ; Kravitz, Brian. / 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. In: Anesthesiology. 2015 ; Vol. 123, No. 1. pp. 55-65.
@article{3f18bce9dd04463f97a389bce2ec9fea,
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 = "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 = "Geoff Frawley and Graham Bell and Nicola Disma and Withington, {Davinia E.} and {De Graaff}, {Jurgen C.} and Morton, {Neil S.} and McCann, {Mary Ellen} and Arnup, {Sarah J.} and Oliver Bagshaw and Andrea Wolfler and David Bellinger and Davidson, {Andrew J.} and Pollyanna Hardy and Hunt, {Rodney W.} and Robyn Stargatt and Gillian Ormond and Penelope Hartmann and Philip Ragg and Marie Backstrom and David Costi and {Von Ungern-Sternberg}, {Britta S.} and Niall Wilton and Graham Knottenbelt and Giovanni Montobbio and Leila Mameli and Pietro Tuo and Gaia Giribaldi and Prato, {Alessio Pini} and Girolamo Mattioli and Francesca Izzo and Ida Salvo and Valter Sonzogni and Locatelli, {Bruno Guido} and Magda Khotcholava 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 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 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 Anthony Chisakuta and Ayman Eissa and Peter Stoddart and Annette Davis and Paul Myles and Andy Wolf and John Carlin and Kate Leslie and {De Lima}, Jonathan and David Field and Val Gebski and Dick Tibboel and Peter Szmuk and Jeffery Steiner and Brian Kravitz",
year = "2015",
month = "7",
day = "20",
doi = "10.1097/ALN.0000000000000708",
language = "English (US)",
volume = "123",
pages = "55--65",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair

T2 - Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes

AU - Frawley, Geoff

AU - Bell, Graham

AU - Disma, Nicola

AU - Withington, Davinia E.

AU - De Graaff, Jurgen C.

AU - Morton, Neil S.

AU - McCann, Mary Ellen

AU - Arnup, Sarah J.

AU - Bagshaw, Oliver

AU - Wolfler, Andrea

AU - Bellinger, David

AU - Davidson, Andrew J.

AU - Hardy, Pollyanna

AU - Hunt, Rodney W.

AU - Stargatt, Robyn

AU - Ormond, Gillian

AU - Hartmann, Penelope

AU - Ragg, Philip

AU - Backstrom, Marie

AU - Costi, David

AU - Von Ungern-Sternberg, Britta S.

AU - Wilton, Niall

AU - Knottenbelt, Graham

AU - Montobbio, Giovanni

AU - Mameli, Leila

AU - Tuo, Pietro

AU - Giribaldi, Gaia

AU - Prato, Alessio Pini

AU - Mattioli, Girolamo

AU - Izzo, Francesca

AU - Salvo, Ida

AU - Sonzogni, Valter

AU - Locatelli, Bruno Guido

AU - Khotcholava, Magda

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 - 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 - 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 - Chisakuta, Anthony

AU - Eissa, Ayman

AU - Stoddart, Peter

AU - Davis, Annette

AU - Myles, Paul

AU - Wolf, Andy

AU - Carlin, John

AU - Leslie, Kate

AU - De Lima, Jonathan

AU - Field, David

AU - Gebski, Val

AU - Tibboel, Dick

AU - Szmuk, Peter

AU - Steiner, Jeffery

AU - Kravitz, Brian

PY - 2015/7/20

Y1 - 2015/7/20

N2 - 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 - 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.

UR - http://www.scopus.com/inward/record.url?scp=84937484952&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937484952&partnerID=8YFLogxK

U2 - 10.1097/ALN.0000000000000708

DO - 10.1097/ALN.0000000000000708

M3 - Article

VL - 123

SP - 55

EP - 65

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 1

ER -