title: Caudal anesthesia with sedation for inguinal hernia repair in high risk neonates.
abstract: OBJECTIVE
  The use of caudal anesthesia with sedation (CAS) has theoretical benefits over general anesthesia (GA) in high risk neonates undergoing inguinal hernia repair. This benefit has not been established in clinical studies. We compare outcomes of these two approaches at a single institution.
  
  
  METHODS
  A retrospective review was performed of all neonates and preterm infants undergoing inguinal hernia over an 8year period.
  
  
  RESULTS
  Of 71 infants meeting inclusion criteria, 50 underwent repair with caudal block and systemic sedation, and 21 with general anesthesia. Minor incidents of respiratory depression requiring non invasive interventions were common in the first 24h post operatively (24% for CAS, 14% with GA), 4% of patients receiving CAS had a respiratory complication which prolonged their hospital stay beyond 24h post operation. Both required conversion to general anesthesia. Statistically significant differences between the two groups were lacking in terms of preoperative risk and post operative outcome.
  
  
  CONCLUSIONS
  CAS is a safe, effective anesthetic option for high risk neonates undergoing inguinal hernia repair. Patients requiring conversion to GA from CAS may be at increased risk for complications. Large, randomized trials are needed to determine any benefit over GA.
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Tripler Army Medical Center, HI.
authors.forename: Eric
authors.initials: E
authors.lastname: Balent
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Tripler Army Medical Center, HI. Electronic address: mary.j.edwards@us.army.mil.
authors.forename: Mary
authors.initials: M
authors.lastname: Edwards
authors.affiliation: Department of Clinical Investigation, Tripler Army Medical Center, Tripler Army Medical Center, HI.
authors.forename: Michael
authors.initials: M
authors.lastname: Lustik
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Tripler Army Medical Center, HI.
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
mesh_terms: D000763:Anesthesia, Caudal / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D007234:Infant, Premature; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Caudal; Inguinal hernia; Neonate; Regional