title: General endotracheal vs. non-endotracheal regional anesthesia for elective inguinal hernia surgery in very preterm neonates: A single institution experience.
abstract: BACKGROUND
  Very pre-term infants (VP) at <32 weeks post menstrual age PMA have a high incidence of bronchopulmonary dysplasia BPD. BPD places them at risk for pulmonary-related perioperative complications from general endotracheal anesthesia GE during elective inguinal hernia repair.
  
  
  METHODS
  A retrospective cohort study was done to compare pulmonary-related perioperative risks between VP patients undergoing non-emergent inguinal hernia repair prior to NICU discharge under GE (n=58) vs regional anesthesia RA (n=37).
  
  
  RESULTS
  Median PMA (RA 26 vs GE 27 weeks), operative weight (RA 2.2 vs GE 2.27 kg), % with BPD, medical and surgical comorbidities, number of concurrent procedures are similar between groups, except for sac laparoscopy (0% RA vs 36% GE). Procedural anesthesia time was 40 minutes for RA vs 69 minutes for GE, (p < 0.001). GE (17%) vs RA (0%) remained intubated post op (p<0.001). Oral feeding was fully tolerated in RA (97%) vs GE (72%, p=0.002) by 48h after surgery. The statistical differences hold after regression analysis controlling for sac laparoscopy and procedure time. No difference in intraoperative or postoperative hernia complications is found.
  
  
  CONCLUSIONS
  RA is safe. RA is associated with early resumption of full feed, avoidance of prolonged mechanical intubation. We recommend a randomized controlled trial comparing the safety and efficacy of GE vs RA in VP infants undergoing elective NICU inguinal hernia repair.
  
  
  METHODS
  II Retrospective study.
authors.affiliation: Children's Hospital of Illinois, University of Illinois College of Medicine at Peoria.
authors.forename: Jean
authors.initials: J
authors.lastname: Gurria
authors.affiliation: Children's Hospital of Illinois, University of Illinois College of Medicine at Peoria.
authors.forename: Phillip
authors.initials: P
authors.lastname: Kuo
authors.affiliation: Children's Hospital of Illinois, University of Illinois College of Medicine at Peoria.
authors.forename: Angie
authors.initials: A
authors.lastname: Kao
authors.affiliation: Children's Hospital of Illinois, University of Illinois College of Medicine at Peoria.
authors.forename: Luisa
authors.initials: L
authors.lastname: Christensen
authors.affiliation: Children's Hospital of Illinois, University of Illinois College of Medicine at Peoria. Electronic address: AiXuan.L.Holterman@osfhealthcare.org.
authors.forename: AiXuan
authors.initials: A
authors.lastname: Holterman
mesh_terms: D000765:Anesthesia, Conduction / Q000009:adverse effects; D000768:Anesthesia, General / Q000009:adverse effects; D001997:Bronchopulmonary Dysplasia / Q000150:complications; D017558:Elective Surgical Procedures; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007431:Intraoperative Complications; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Bronchopulmonary dysplasia; Hernia; Inguinal; Neonatal; Preterm; Repair