title: Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial.
abstract: BACKGROUND
  Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia.
  
  
  METHODS
  Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded.
  
  
  RESULTS
  Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3%; OR, 0.20; 95% CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) was 2% in both RA and GA arms (OR, 1.17; 95% CI, 0.41 to 3.33; P = 0.7688). The strongest predictor of apnea was prematurity (OR, 21.87; 95% CI, 4.38 to 109.24), and 96% of infants with apnea were premature.
  
  
  CONCLUSIONS
  RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.
authors.affiliation: From the Anaesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia (A.J.D., G.F., G.O.); Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Victoria, Australia (A.J.D., G.F.); Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia (A.J.D., G.F., R.W.H.); Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, United Kingdom (N.S.M.); Department of Anaesthesia, Royal Hospital for Sick Children, Glasgow, United Kingdom (N.S.M.); Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia (S.J.A.); Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands (J.C.d.G.); Department of Anesthesia, Istituto Giannina Gaslini, Genoa, Italy (N.D., P.T.); Department of Anaesthesia, Montreal Children's Hospital, Montreal, Quebec, Canada (D.E.W.); Department of Anesthesia, McGill University, Montreal, Quebec, Canada (D.E.W.); Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia (R.W.H.); Neonatal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia (R.W.H.); National Perinatal Epidemiology Unit, Clinical Trials Unit, University of Oxford, Oxford, United Kingdom (P.H.); Department of Anaesthesia, Ospedale Papa Giovanni XXIII, Bergamo, Italy (M.K., B.G.L.); Pharmacology, Pharmacy, Anaesthesiology Unit, School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (B.S.v.U.S.); Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Western Australia, Australia (B.S.v.U.S.); Department of Paediatric Anaesthesia and Operating Rooms, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand (N.W.); Department of Anesthesiology and Paedi
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Davidson
authors.forename: Neil S
authors.initials: NS
authors.lastname: Morton
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Arnup
authors.forename: Jurgen C
authors.initials: JC
authors.lastname: de Graaff
authors.forename: Nicola
authors.initials: N
authors.lastname: Disma
authors.forename: Davinia E
authors.initials: DE
authors.lastname: Withington
authors.forename: Geoff
authors.initials: G
authors.lastname: Frawley
authors.forename: Rodney W
authors.initials: RW
authors.lastname: Hunt
authors.forename: Pollyanna
authors.initials: P
authors.lastname: Hardy
authors.forename: Magda
authors.initials: M
authors.lastname: Khotcholava
authors.forename: Britta S
authors.initials: BS
authors.lastname: von Ungern Sternberg
authors.forename: Niall
authors.initials: N
authors.lastname: Wilton
authors.forename: Pietro
authors.initials: P
authors.lastname: Tuo
authors.forename: Ida
authors.initials: I
authors.lastname: Salvo
authors.forename: Gillian
authors.initials: G
authors.lastname: Ormond
authors.forename: Robyn
authors.initials: R
authors.lastname: Stargatt
authors.forename: Bruno Guido
authors.initials: BG
authors.lastname: Locatelli
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: McCann
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects* / Q000639:trends; D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000639:trends; D001049:Apnea / Q000175:diagnosis* / Q000209:etiology; D002657:Child Development / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D038622:Internationality; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D012307:Risk Factors; D016896:Treatment Outcome; D014851:Wakefulness