Kiblawi Rim, Beck Christiane, Keil Oliver, Schukfeh Nagoud, Hofmann Alejandro Daniel, Ure Benno Manfred, Kuebler Joachim Friedrich
Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany.
Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Niedersachsen, Germany.
Eur J Pediatr Surg. 2023 Feb;33(1):26-34. doi: 10.1055/a-1958-7989. Epub 2022 Oct 11.
Minimally invasive surgery (i.e., laparoscopy) and minimally invasive anesthesia (i.e., caudal anesthesia with spontaneous respiration) have separately shown benefits for inguinal hernia repair in infants, yet to what degree these techniques can be combined remains unknown. This study investigated whether laparoscopy impacts the feasibility of performing caudal anesthesia with spontaneous respiration in infants.
Prospectively collected data of all infants less than 12 months old and over 3 kg weight who underwent laparoscopic indirect hernia repair (LAP) at our department from 2019 to 2021 were compared with a historical control-matched group of infants who underwent open repair (OPEN) from 2017 to 2021. We assessed the patients' characteristics, anesthesia, and surgical data as well as intra- and postoperative complications.
A total of 87 infants were included (LAP = 29, OPEN = 58). Caudal anesthesia with spontaneous respiration was feasible in 62.1% of cases (LAP = 55.2%, OPEN = 65.5%; nonsignificant). Neither group registered anesthetic intra- or postoperative complications. Sedatives were utilized in 97% of LAP patients versus 56.9% of OPEN patients ( < 0.00001). The airway was secured with a laryngeal mask in 89.7% of patients during LAP versus 41.4% during OPEN ( < 0.00001). No significant differences were found regarding the use frequency of opioids (48.3% LAP vs. 34.5% OPEN; nonsignificant) or neuromuscular blockers (6.9% LAP vs. 5.2% OPEN; nonsignificant).
This is the first comparative study on caudal anesthesia and spontaneous respiration in infants undergoing laparoscopic versus open inguinal hernia surgery. Laparoscopy increased the need for ventilatory support and sedatives but did not significantly impair the feasibility of caudal anesthesia and spontaneous respiration.
微创手术（即腹腔镜手术）和微创麻醉（即保留自主呼吸的骶管麻醉）已分别显示出对婴儿腹股沟疝修补术有益，但这些技术能在何种程度上结合尚不清楚。本研究调查了腹腔镜手术是否会影响婴儿进行保留自主呼吸的骶管麻醉的可行性。
将2019年至2021年在我科接受腹腔镜下间接疝修补术（LAP）的所有年龄小于12个月、体重超过3kg的婴儿的前瞻性收集数据，与2017年至2021年接受开放修补术（OPEN）的历史对照匹配组婴儿的数据进行比较。我们评估了患者的特征、麻醉和手术数据以及术中及术后并发症。
共纳入87例婴儿（LAP组=29例，OPEN组=58例）。62.1%的病例中保留自主呼吸的骶管麻醉是可行的（LAP组=55.2%，OPEN组=65.5%；无显著差异）。两组均未出现麻醉相关的术中或术后并发症。97%的LAP组患者使用了镇静剂，而OPEN组为56.9%（<0.00001）。LAP组89.7%的患者在术中使用喉罩确保气道安全，而OPEN组为41.4%（<0.00001）。在阿片类药物使用频率（LAP组48.3% vs. OPEN组34.5%；无显著差异）或神经肌肉阻滞剂使用频率（LAP组6.9% vs. OPEN组5.2%；无显著差异）方面未发现显著差异。
这是第一项关于接受腹腔镜与开放腹股沟疝手术的婴儿骶管麻醉和自主呼吸的比较研究。腹腔镜手术增加了通气支持和镇静剂的需求，但并未显著损害骶管麻醉和自主呼吸的可行性。
