Postoperative apnea among premature or anemic infants undergoing inguinal hernia repair
Iranian Journal of Pediatric Surgery,
Vol. 2 No. 2 (2016),
Introduction: Premature or anemic newborns undergoing hernia repair are prone to more postoperative complications than full-term infants. The incidence of respiratory complications among these patients is more than 30%, being postoperative apnea the most common. Some investigators found that gestational and postconceptional age, the presence of continuing apneic episodes and anemia are the main determinants of postoperative apnea. It seems that infants who do not receive intravenous anesthetics experience less respiratory complications. Intravenous anesthetics have hepatic metabolism for elimination and the immature liver of the premature has not sufficient elimination capacity.
Materials and Methods: Study participants were 1047 neonates with post conceptual age (PCA) lower than 60 weeks undergoing inguinal hernia operation. Sevoflurane gas mask was used for anesthesia induction and during deep anesthesia, caudal block was administered using 1cc/kg bupivacaine 2%. The neonates were managed with spontaneous breathing with Sevoflurane gas mask or endotracheal tube until the end of the operation.
Results: In the present study, 916 (87.5%) male and 131 (12.5%) female neonates were included. Mean gestational age and PCA were 36.62 ± 38.0 and 46.80 ± 45.60 weeks respectively. Postoperative apnea did not occur in any patient.
Conclusion: Many studies confirm our findings that inhaled sedative drugs without hepatic or renal metabolism are safe for sedation of premature or anemic infants.
- Inguinal hernia
- Anemic infant
How to Cite
Ozdemir T, Arikan A: Postoperative apnea after inguinal hernia repair in formerly premature infants: impacts of gestational age, postconceptional age and comorbidities. Pediatric surgery international 2013;29:801-4.
Steward DJ: Preterm infants are more prone to complications following minor surgery than are term infants. Anesthesiology 1982;56:304-6.
Krane EJ, Haberkern CM, Jacobson LE: Postoperative apnea, bradycardia, and oxygen desaturation in formerly premature infants: prospective comparison of spinal and general anesthesia. Anesthesia and analgesia 1995;80:7-13.
Kim GS, Song JG, Gwak MS, et al: Postoperative outcome in formerly premature infants undergoing herniorrhaphy: comparison of spinal and general anesthesia. Journal of Korean medical science 2003;18:691-5.
Sale SM, Read JA, Stoddart PA, et al: Prospective comparison of sevoflurane and desflurane in formerly premature infants undergoing inguinal herniotomy. British journal of anaesthesia 2006;96:774-8.
Edraki M, Pourpulad H, Kargar M, et al: Olfactory stimulation by vanillin prevents apnea in premature newborn infants. Iranian journal of pediatrics 2013;23:261-8.
Malviya S, Swartz J, Lerman J: Are all preterm infants younger than 60 weeks postconceptual age at risk for postanesthetic apnea? Anesthesiology 1993;78:1076-81.
Gollin G, Bell C, Dubose R, et al: Predictors of postoperative respiratory complications in premature infants after inguinal herniorrhaphy. Journal of pediatric surgery 1993;28:244-7.
Henderson-Smart DJ: The effect of gestational age on the incidence and duration of recurrent apnoea in newborn babies. Australian paediatric journal 1981;17:273-6.
Pillekamp F, Hermann C, Keller T, et al: Factors influencing apnea and bradycardia of prematurity - implications for neurodevelopment. Neonatology 2007;91:155-61.
Weiss M, Gerber AC: Rapid sequence induction in children -- it's not a matter of time! Paediatric anaesthesia 2008;18:97-9.
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