Departmnt of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tübingen, Germany.
Clinic for Anesthesiology, Intensive, Emergency- and Pain-Therapy, Ludwigsburg, Germany.
BMC Anesthesiol. 2020 Jul 20;20(1):175. doi: 10.1186/s12871-020-01094-8.
Intraoperative blood pressure is a relevant variable for postoperative outcome in infants undergoing surgical procedures. It is therefore important to know whether the type of anesthesia has an impact on intraoperative blood pressure management in very low birth weight infants. Here, we retrospectively analyzed intraoperative blood pressure in very low birthweight infants receiving either awake caudal anesthesia without sedation, or caudal block in combination with general anesthesia, both for open inguinal hernia repair.
Ethical approval was provided by the University of Tuebingen Ethical Committee on 05/29/2018 with the project number 403/2018BO2. Patient records of infants admitted by the neonatologist (median age at birth 31.1 ± 3.5 weeks, median weight at birth 1240 ± 521 g) which were scheduled for inguinal hernia repair were retrospectively evaluated for the course of mean arterial blood pressure and perioperative interventions to stabilize blood pressure. A total of 42 patients were included, 16 patients (11 boys, 5 girls) received awake caudal anesthesia, 26 patients (22 boys, 4 girls) a combination of general anesthesia and caudal block.
Approximately 3% of the measured mean arterial blood pressure values in the caudal anesthesia group were below a critical margin of 35 mmHg, in contrast to 47% in the combined anesthesia group (p < 0.001). Patients in the latter group showed a significantly larger drop of mean arterial blood pressure below 35 mmHg (4.7 ± 2.7 mmHg vs. 1.9 ± 1.6 mmHg; p < 0.005) and a significantly longer time of mean arterial blood pressure below 35 mmHg (25.6 ± 26.0 min vs. 0.9 ± 2.3 min; p < 0.001), although they received more volume and vasopressor boluses for stabilization (27 ± 14.8 ml vs. 10 ± 4.1 ml; p < 0.01 and 0.15 ± 0.06 ml vs. 0 ml of cafedrine/theoadrenaline; p < 0.001).
The study indicates that the use of caudal block as stand alone procedure for inguinal hernia repair in very low birthweight infants might be advantageous in preventing critical blood pressure drops compared to a combination of caudal block with general anesthesia.
术中血压是婴儿接受手术治疗后术后结果的一个相关变量。因此，了解麻醉类型是否会影响极低出生体重儿的术中血压管理非常重要。在这里，我们回顾性分析了接受清醒骶麻而未镇静或骶麻联合全身麻醉行开放腹股沟疝修补术的极低出生体重儿的术中血压。
2018 年 5 月 29 日，图宾根大学伦理委员会批准了本研究（项目编号 403/2018BO2）。本研究回顾性评估了由新生儿科医生收治的（出生时中位年龄 31.1±3.5 周，出生时中位体重 1240±521g）计划行腹股沟疝修补术的婴儿的平均动脉血压和围手术期稳定血压的干预措施。共纳入 42 例患者，16 例（11 名男性，5 名女性）接受清醒骶麻，26 例（22 名男性，4 名女性）接受骶麻联合全身麻醉。
在骶麻组中，约有 3%的平均动脉血压值低于 35mmHg 的临界值，而在联合麻醉组中，这一比例为 47%（p<0.001）。与后者相比，前者的平均动脉血压明显下降（4.7±2.7mmHg 比 1.9±1.6mmHg；p<0.005），平均动脉血压低于 35mmHg 的时间明显延长（25.6±26.0min 比 0.9±2.3min；p<0.001），尽管他们接受了更多的容量和血管加压药冲击剂量以稳定血压（27±14.8ml 比 10±4.1ml；p<0.01 和 0.15±0.06ml 比 0ml 的苯福林/去甲肾上腺素；p<0.001）。
本研究表明，与骶麻联合全身麻醉相比，在极低出生体重儿中，单独使用骶麻行腹股沟疝修补术可能有利于预防血压的严重下降。
