PMID- 27281725
OWN - NLM
STAT- MEDLINE
DCOM- 20170313
LR  - 20211203
IS  - 1532-8651 (Electronic)
IS  - 1098-7339 (Print)
IS  - 1098-7339 (Linking)
VI  - 41
IP  - 4
DP  - 2016 Jul-Aug
TI  - Adverse Events and Resource Utilization After Spinal and General Anesthesia in 
      Infants Undergoing Pyloromyotomy.
PG  - 532-7
LID - 10.1097/AAP.0000000000000421 [doi]
AB  - BACKGROUND AND OBJECTIVES: Interest in spinal anesthesia (SA) is increasing 
      because of concern about the long-term effects of intravenous (IV) and inhaled 
      anesthetics in young children. This study compared SA versus general anesthesia 
      (GA) in infants undergoing pyloromyotomy. METHODS: Between 2000 to 2013, the 
      University of Vermont Medical Center almost exclusively used SA for infant 
      pyloromyotomy surgery, whereas Columbia University Medical Center relied on GA. 
      Outcomes included adverse events (AEs) within 48 hours of surgery, operating room 
      (OR) time, and postoperative length of stay (LOS). Regression was used to 
      evaluate the association between anesthesia technique and outcomes, accounting 
      for demographic and clinical covariates. RESULTS: We studied 218 infants with SA 
      at the University of Vermont Medical Center and 206 infants with GA at Columbia 
      University Medical Center. In the SA group, 96.3% of infants had adequate initial 
      analgesic levels, but 35.8% required supplemental IV or inhaled anesthetic 
      agents. Compared with GA, the risk of AEs in SA (adjusted odds ratio, 0.60; 95% 
      confidence interval [CI], 0.27-1.36) did not significantly differ, but SA was 
      associated with shorter OR times (17.5 minutes faster; 95% CI, 13.5-21.4 minutes) 
      and shorter postoperative LOS (GA is 1.19 times longer; 95% CI, 1.01-1.40). 
      CONCLUSIONS: Infants undergoing pyloromyotomy with SA had shorter OR times and 
      postoperative LOS, no significant differences in AE rates, and decreased exposure 
      to IV and inhaled anesthetics, although SA infants often still required 
      supplemental anesthetics. Whether these differences result in any long-term 
      benefit is unclear; further studies are needed to determine the risk of rare AEs, 
      such as aspiration.
FAU - Ing, Caleb
AU  - Ing C
AD  - From the Departments of *Anesthesiology and daggerPediatrics, Columbia University 
      College of Physicians and Surgeons, New York, NY; double daggerDepartment of Anesthesiology, 
      University of Vermont Medical Center, Burlington, VT;  section signMailman School of Public 
      Health, Columbia University; and  parallelDepartment of Epidemiology, Columbia University 
      College of Physicians and Surgeons, New York, NY; and  paragraph signDepartment of Pediatrics, 
      University of Vermont Medical Center, Burlington, VT.
FAU - Sun, Lena S
AU  - Sun LS
FAU - Friend, Alexander F
AU  - Friend AF
FAU - Roh, Arthur
AU  - Roh A
FAU - Lei, Susan
AU  - Lei S
FAU - Andrews, Howard
AU  - Andrews H
FAU - Li, Guohua
AU  - Li G
FAU - Williams, Robert K
AU  - Williams RK
LA  - eng
GR  - K08 HS022941/HS/AHRQ HHS/United States
GR  - UL1 TR000040/TR/NCATS NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PL  - England
TA  - Reg Anesth Pain Med
JT  - Regional anesthesia and pain medicine
JID - 9804508
RN  - 0 (Anesthetics, Inhalation)
RN  - 0 (Anesthetics, Intravenous)
SB  - IM
MH  - Academic Medical Centers
MH  - Anesthesia, General/*adverse effects
MH  - Anesthesia, Spinal/*adverse effects
MH  - Anesthetics, Inhalation/adverse effects
MH  - Anesthetics, Intravenous/adverse effects
MH  - Chi-Square Distribution
MH  - Digestive System Surgical Procedures/*adverse effects
MH  - Female
MH  - Health Resources/*statistics & numerical data
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Length of Stay
MH  - Linear Models
MH  - Logistic Models
MH  - Male
MH  - New York City
MH  - Odds Ratio
MH  - Operative Time
MH  - Postoperative Complications/diagnosis/etiology/*therapy
MH  - Pyloric Stenosis, Hypertrophic/diagnosis/*surgery
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vermont
PMC - PMC4912426
MID - NIHMS780170
EDAT- 2016/06/10 06:00
MHDA- 2017/03/14 06:00
PMCR- 2017/07/01
CRDT- 2016/06/10 06:00
PHST- 2016/06/10 06:00 [entrez]
PHST- 2016/06/10 06:00 [pubmed]
PHST- 2017/03/14 06:00 [medline]
PHST- 2017/07/01 00:00 [pmc-release]
AID - 10.1097/AAP.0000000000000421 [doi]
PST - ppublish
SO  - Reg Anesth Pain Med. 2016 Jul-Aug;41(4):532-7. doi: 10.1097/AAP.0000000000000421.