Abstract
BackgroundIntraoperative blood pressure is a relevant variable for postoperative outcome in infants undergoing surgical procedures. It is therefore important to know whether the type of anesthesia has an impact on intraoperative blood pressure management in very low birth weight infants. Here, we retrospectively analyzed intraoperative blood pressure in very low birthweight infants receiving either awake caudal anesthesia without sedation, or caudal block in combination with general anesthesia, both for open inguinal hernia repair.MethodsEthical approval was provided by the University of Tuebingen Ethical Committee on 05/29/2018 with the project number 403/2018BO2. Patient records of infants admitted by the neonatologist (median age at birth 31.1 ± 3.5 weeks, median weight at birth 1240 ± 521 g) which were scheduled for inguinal hernia repair were retrospectively evaluated for the course of mean arterial blood pressure and perioperative interventions to stabilize blood pressure. A total of 42 patients were included, 16 patients (11 boys, 5 girls) received awake caudal anesthesia, 26 patients (22 boys, 4 girls) a combination of general anesthesia and caudal block.ResultsApproximately 3% of the measured mean arterial blood pressure values in the caudal anesthesia group were below a critical margin of 35 mmHg, in contrast to 47% in the combined anesthesia group (p < 0.001). Patients in the latter group showed a significantly larger drop of mean arterial blood pressure below 35 mmHg (4.7 ± 2.7 mmHg vs. 1.9 ± 1.6 mmHg; p < 0.005) and a significantly longer time of mean arterial blood pressure below 35 mmHg (25.6 ± 26.0 min vs. 0.9 ± 2.3 min; p < 0.001), although they received more volume and vasopressor boluses for stabilization (27 ± 14.8 ml vs. 10 ± 4.1 ml; p < 0.01 and 0.15 ± 0.06 ml vs. 0 ml of cafedrine/theoadrenaline; p < 0.001).ConclusionsThe study indicates that the use of caudal block as stand alone procedure for inguinal hernia repair in very low birthweight infants might be advantageous in preventing critical blood pressure drops compared to a combination of caudal block with general anesthesia.
Highlights
Intraoperative blood pressure is a relevant variable for postoperative outcome in infants undergoing surgical procedures
We already know from previous studies that arterial blood pressure is not altered by caudal anesthesia in children receiving general anesthesia [6], a finding that was supported by a prospective study in neonates by Deng et al [7]
At our institution we left treating preterm neonates for inguinal hernia repair without caudal block over a decade, since we rated the well-known advantages of regional anesthesia as so convincing [9, 10]
Summary
Intraoperative blood pressure is a relevant variable for postoperative outcome in infants undergoing surgical procedures. It is important to know whether the type of anesthesia has an impact on intraoperative blood pressure management in very low birth weight infants. McCann et al have reported a case series with pediatric patients suffering from infantile postoperative encephalopathy after the occurrence of intraoperative hypotension [3]. This raises the question whether the type of anesthesia has an impact on the need for active intraoperative blood pressure management. Ing et al have demonstrated that spinal anesthesia performed in healthy infants undergoing pyloromyotomy results in reduced intraoperative blood pressure changes from baseline compared to general anesthesia [5]. We already know from previous studies that arterial blood pressure is not altered by caudal anesthesia in children receiving general anesthesia [6], a finding that was supported by a prospective study in neonates by Deng et al [7]
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