婴儿清醒区域麻醉和全身麻醉后的呼吸暂停：全身麻醉与脊髓麻醉比较研究——比较呼吸暂停和神经发育结局，一项随机对照试验
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.
作者信息
Davidson Andrew J, Morton Neil S, Arnup Sarah J, de Graaff Jurgen C, Disma Nicola, Withington Davinia E, Frawley Geoff, Hunt Rodney W, Hardy Pollyanna, Khotcholava Magda, von Ungern Sternberg Britta S, Wilton Niall, Tuo Pietro, Salvo Ida, Ormond Gillian, Stargatt Robyn, Locatelli Bruno Guido, McCann Mary Ellen
机构信息
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
出版信息
Anesthesiology. 2015 Jul;123(1):38-54. doi: 10.1097/ALN.0000000000000709.
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.
背景
术后呼吸暂停是幼儿的一种并发症。清醒区域麻醉（RA）可能会降低风险；然而，证据并不充分。全身麻醉与脊髓麻醉比较研究是一项随机对照试验，旨在评估全身麻醉（GA）对神经发育的影响。次要目的是比较麻醉后呼吸暂停的发生率。
方法
计划进行腹股沟疝修补术的60周龄及以下的婴儿，根据月经龄随机分为RA组或GA组。排除标准包括神经发育不良的危险因素以及妊娠少于26周出生的婴儿。该分析的主要结局是术后12小时内观察到的任何呼吸暂停。呼吸暂停评估未设盲。
结果
363例患者被分配至RA组，359例被分配至GA组。总体而言，两组呼吸暂停（0至12小时）的发生率相似（RA组为3%，GA组为4%；优势比[OR]为0.63；95%可信区间[CI]为0.31至1.30，P = 0.2133）；然而，RA组早期呼吸暂停（0至30分钟）的发生率较低（1%对3%；OR为0.20；95%CI为0.05至0.91；P = 0.0367）。RA组和GA组晚期呼吸暂停（30分钟至12小时）的发生率均为2%（OR为1.17；95%CI为0.41至3.33；P = 0.7688）。呼吸暂停最强的预测因素是早产（OR为21.87；95%CI为4.38至109.24），96%的呼吸暂停婴儿为早产儿。
结论
接受腹股沟疝修补术的婴儿采用RA可降低术后早期的呼吸暂停发生率。所有早产婴儿均应进行心肺监测。
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