Narkosekomplikationen im Säuglingsalter : eine retrospektive Vergleichsstudie zwischen Intubationsnarkose und Spinalanästhesie an Säuglingen mit Leistenhernienoperationen unter besonderer Berücksichtigung postoperativer Apnoephasen

Subject of this study was to compare general anaesthesia and spinal anaesthesia in infants. Anaesthetic complications and postoperative apnea were discovered and subsequently compared refer to the anaesthetic technique. For that purpose the patient records of all infants undergoing inguinal hernia repair at University Hospital Aachen between 1997 and 2003 were collected and examined retrospectively. Altogether 275 infants could be included in this study of which 166 received general anaesthesia (ITN group) and 109 received spinal anaesthesia (SPA group). For general anaesthesia muscle relaxants were used at introduction, volatile anaesthetics were used for maintenance in 95% (including 65% Sevofluran) and for intraoperativ analgesia opioid (Fentanyl, Piritramid) was used in 2/3 of the patients. For spinal anaesthesia only isobaric Bupivacaine 0.5% in dosage 1 mg/kg (body weight minus 10%) was injected. The comparisons of pre-existing conditions of the infants refer to the chosen anaesthetic technique showed significant statistical differences: The infants in SPA group had a lower birth weight and have been born in earlier pregnancy, at operation the postmenstrual age and body weight was lower; also a higher grade of comorbidity was demonstrated. For summary the infants in SPA group had already preoperative a higher disposition to develop perioperative complications or postoperative apnea. Postoperative apnea was detected by respiration monitors and/or monitoring of peripheral oxygen saturation. Intraoperative anaesthetic complications was analysed separately from apnea complications: Within the ITN group 16.9% of the infants demonstrated intraoperative anaesthetic complications whereas in SPA group none was described (p=0.000). Postoperative new occurred apnea was demonstrated by 14 infants of ITN group and one infant of SPA group (p=0.020). The analysis of subgroups (infants after postpartal respirator-therapy (n=66), infants with pulmonal diseases (n=73), ex-premature infants (n=142), infants with less than 1500g birth weight (n=67)) showed significant advantages for the use of spinal anaesthesia. Critical analysis of already published studies concerning anaesthetic complications and postoperative apnea in infants demonstrates great variability but in all more complications and higher incidence of postoperative apnea in general anaesthesia. The risk of anaesthetic complications or postoperative apnea is lower in spinal anaesthesia compared to general anaesthesia, but even after spinal anaesthesia postoperative apnea can occur, which is important concerning ambulatory surgery and postoperative monitoring. For conclusion this study shows that spinal anaesthesia can be recommended as a save and effective anaesthetic technique especially in high-risk infants with pre-existing diseases.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2006

Author dc:creator

• Fischer, Robert

Contributors dc:contributor

• Rossaint, Rolf

• info:eu-repo/classification/ddc/610
• Medizin
• Spinalanästhesie
• Intubationsnarkose
• Leistenhernie
• Frühgeborenes
• Komplikation
• Perioperative Phase
• Apnoe
• Säuglinge
• spinal anaesthesia
• general anaesthesia
• hernia repair
• infant
• peri-operative complications

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-122856%22

OAI identifier oai:identifier

oai:publications.rwth-aachen.de:61176