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, General Anesthesia Compared to Spinal Anesthesia (GAS) Study Consortium, Suzette Sheppard & 4 others Penelope Hartmann, Paul Myles, John Carlin, Kate Leslie

Research output: Contribution to journalArticleResearchpeer-review

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
Pages (from-to)38-54
Number of pages17
JournalAnesthesiology
Volume123
Issue number1
DOIs
Publication statusPublished - 20 Jul 2015

Cite this

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 ; General Anesthesia Compared to Spinal Anesthesia (GAS) Study Consortium ; Sheppard, Suzette ; Hartmann, Penelope ; Myles, Paul ; Carlin, John ; Leslie, Kate. / 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 {General Anesthesia Compared to Spinal Anesthesia (GAS) Study Consortium} and Suzette Sheppard and Penelope Hartmann and Paul Myles and John Carlin and Kate Leslie",
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doi = "10.1097/ALN.0000000000000709",
language = "English",
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journal = "Anesthesiology",
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publisher = "American Society of Anesthesiologists",
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}

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, General Anesthesia Compared to Spinal Anesthesia (GAS) Study Consortium, Sheppard, S, Hartmann, P, Myles, P, Carlin, J & Leslie, K 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

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; General Anesthesia Compared to Spinal Anesthesia (GAS) Study Consortium; Sheppard, Suzette; Hartmann, Penelope; Myles, Paul; Carlin, John; Leslie, Kate.

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

Research output: Contribution to journalArticleResearchpeer-review

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 - General Anesthesia Compared to Spinal Anesthesia (GAS) Study Consortium

AU - Sheppard, Suzette

AU - Hartmann, Penelope

AU - Myles, Paul

AU - Carlin, John

AU - Leslie, Kate

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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