Impact of spinal anesthesia for open pyloromyotomy on operating room time.
OBJECTIVE
When pyloromyotomy for hypertrophic pyloric stenosis (HPS) is performed under general anesthesia, metabolic abnormalities and fluid deficits coupled with residual anesthetics may increase the risk of postoperative apnea, thereby, prolonging operating room time and delaying extubation. Spinal anesthesia has been found to reduce the rate of postoperative apnea in high-risk infants. The aim of the study was to evaluate the effect of spinal vs general anesthesia on operating room time in infants undergoing open pyloromyotomy.


METHODS
Data for 60 infants who underwent pyloromyotomy under spinal (n = 24) or general (n = 36) anesthesia at a tertiary pediatric medical center were derived from the computerized database. Primary outcome measures were total operating room time, procedure duration, anesthesia release time, wake-up time, and anesthesia control time (anesthesia release plus wake-up). Nonparametric Mann-Whitney test was used for statistical analysis, and Levene's test was used to assess the equality of variances in samples; P <or= .05 was considered significant.


RESULTS
Mean total operating room time was 50.9 (12.1) minutes in the spinal anesthesia group and 69.5 (26.8) minutes in the general anesthesia group (P = .001). Corresponding values for mean wake-up time were 3.6 (2.9) and 17.2 (25.3) minutes (P < .001), and for mean anesthesia control time, 13.2 (6.7) and 28.5 (24.6) minutes (P < .001). There were no between-group differences in procedure duration or anesthesia release time. On Levene's test, between-group differences were significant for total operating time and wake-up time (P = .01 for both).


CONCLUSIONS
The use of spinal anesthesia for open pyloromyotomy in infants with HPS shortens the operating room time by reducing the wake-up time.
Department of Anesthesia, Schneider Children's Medical Center of Israel, Petah Tiqwa and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 49202, Israel. kachko_l@hotmail.com
Ludmyla
L
Kachko
Eliahu
E
Simhi
Enrique
E
Freud
Elena
E
Dlugy
Jacob
J
Katz
D000768:Anesthesia, General / Q000379:methods / Q000706:statistics & numerical data; D000775:Anesthesia, Spinal / Q000379:methods / Q000706:statistics & numerical data*; D001049:Apnea / Q000517:prevention & control; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D009873:Operating Rooms / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control; D046248:Pyloric Stenosis, Hypertrophic / Q000151:congenital / Q000601:surgery*; D013997:Time Factors; D014851:Wakefulness