Adverse Events and Resource Utilization After Spinal and General Anesthesia in Infants Undergoing Pyloromyotomy.
OBJECTIVE
Interest in spinal anesthesia (SA) is increasing because of concern about the long-term effects of intravenous (IV) and inhaled anesthetics in young children. This study compared SA versus general anesthesia (GA) in infants undergoing pyloromyotomy.


METHODS
Between 2000 to 2013, the University of Vermont Medical Center almost exclusively used SA for infant pyloromyotomy surgery, whereas Columbia University Medical Center relied on GA. Outcomes included adverse events (AEs) within 48 hours of surgery, operating room (OR) time, and postoperative length of stay (LOS). Regression was used to evaluate the association between anesthesia technique and outcomes, accounting for demographic and clinical covariates.


RESULTS
We studied 218 infants with SA at the University of Vermont Medical Center and 206 infants with GA at Columbia University Medical Center. In the SA group, 96.3% of infants had adequate initial analgesic levels, but 35.8% required supplemental IV or inhaled anesthetic agents. Compared with GA, the risk of AEs in SA (adjusted odds ratio, 0.60; 95% confidence interval [CI], 0.27-1.36) did not significantly differ, but SA was associated with shorter OR times (17.5 minutes faster; 95% CI, 13.5-21.4 minutes) and shorter postoperative LOS (GA is 1.19 times longer; 95% CI, 1.01-1.40).


CONCLUSIONS
Infants undergoing pyloromyotomy with SA had shorter OR times and postoperative LOS, no significant differences in AE rates, and decreased exposure to IV and inhaled anesthetics, although SA infants often still required supplemental anesthetics. Whether these differences result in any long-term benefit is unclear; further studies are needed to determine the risk of rare AEs, such as aspiration.
From the Departments of *Anesthesiology and †Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY; ‡Department of Anesthesiology, University of Vermont Medical Center, Burlington, VT; §Mailman School of Public Health, Columbia University; and ∥Department of Epidemiology, Columbia University College of Physicians and Surgeons, New York, NY; and ¶Department of Pediatrics, University of Vermont Medical Center, Burlington, VT.
Caleb
C
Ing
Lena S
LS
Sun
Alexander F
AF
Friend
Arthur
A
Roh
Susan
S
Lei
Howard
H
Andrews
Guohua
G
Li
Robert K
RK
Williams
D000046:Academic Medical Centers; D000768:Anesthesia, General / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D009519:New York City; D016017:Odds Ratio; D061646:Operative Time; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D046248:Pyloric Stenosis, Hypertrophic / Q000175:diagnosis / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014707:Vermont
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous