title: The postoperative occurrence of cardio-respiratory adverse events in small infants undergoing gastrointestinal surgery: a prospective comparison of general anesthesia and combined spinal-epidural anesthesia.
abstract: BACKGROUND
  This study was designed to compare the occurrences of postoperative cardio-respiratory adverse events during an 8-day follow-up period in the neonatal intensive care unit in small infants who underwent elective gastrointestinal surgery under general and combined spinal epidural anesthesia.
  
  
  METHODS
  Fifty infants who underwent elective primary gastrointestinal surgery were randomly divided into two anesthetic techniques. General anesthesia (25 patients) and combined spinal-epidural anesthesia (25 patients). The frequency and types of postoperative cardiovascular and respiratory adverse events in the two groups were recorded and compared during an 8-day follow-up period in the neonatal intensive care unit.
  
  
  RESULTS
  The total number of postoperative respiratory adverse events and the number of infants who experienced at least one respiratory adverse event were statistically more in infants anesthetised by general anesthesia than in infants who were anesthetised by combined spinal-epidural anesthesia, respectively (p < 0.0001) and (RR = 2.5; 95% CI 1.2-5.3). There were significantly more cardiovascular adverse events in the general anesthesia infants than in the combined spinal-epidural anesthesia (p = 0.005). These adverse cardiovascular events were also more resistant to treatment in the general anesthesia infants than in the combined spinal-epidural anesthesia infants (p = 0.001).
  
  
  CONCLUSIONS
  Compared to general anesthesia, combined spinal-epidural anesthesia reduces the frequency of postoperative respiratory adverse events and improves the postoperative cardiovascular stability in small infants who undergo elective gastrointestinal surgery.
authors.affiliation: Anesthesiology Department, Bnai Zion Medical Center, Technion-Israel Institute of Technology, The Ruth & Bruce Faculty of Medicine, Haifa, Israel. somri_m@yahoo.com
authors.forename: Mostafa
authors.initials: M
authors.lastname: Somri
authors.forename: Arnold G
authors.initials: AG
authors.lastname: Coran
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Mattar
authors.forename: Christian
authors.initials: C
authors.lastname: Teszler
authors.forename: Ron
authors.initials: R
authors.lastname: Shaoul
authors.forename: Oren
authors.initials: O
authors.lastname: Tomkins
authors.forename: Riad
authors.initials: R
authors.lastname: Tome
authors.forename: Jorge G
authors.initials: JG
authors.lastname: Mogilner
authors.forename: Igor
authors.initials: I
authors.lastname: Sukhotnik
authors.forename: Luis
authors.initials: L
authors.lastname: Gaitini
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000768:Anesthesia, General / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007557:Israel / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors