Subarachnoid anesthesia (with and without sedation) versus general anesthesia for ex-preterm neonates undergoing elective infraumbilical operations

Background Postoperative respiratory problems, especially apnea, is a common postoperative complication in ex-preterm neonates undergoing infraumbilical operations. So, most of these neonates require close postoperative monitoring for at least 12 h to avoid this hazard. Postoperative apnea is related more to the use of respiratory depressant drugs used during general anesthesia. Aim The aim was to evaluate safety and effectiveness of spinal anesthesia in ex-preterm infants undergoing infraumbilical operations and evaluate its role in elimination of routine postoperative hospital stay for apnea monitoring. Settings and design A prospective single-blinded randomized study was conducted. Materials and methods From March 2015 to March 2016, 105 ex-preterm neonates (gestational age <37 weeks), with postconceptual age at surgery less than 60 weeks, undergoing elective infraumbilical operations were studied prospectively. Patients were divided randomly into three groups (35 patients each). Group I received spinal anesthesia without sedation (only sugared pacifier), group II received spinal anesthesia with sedation in the form of ketamine/midazolam, and group III received general anesthesia with caudal analgesia. Postoperative apnea, bradycardia, and oxygen saturation were observed and compared for 12 h after operation. The primary outcome measures were postoperative apnea, postoperative bradycardia, and SpO2. The secondary outcome measures were postoperative complications (e.g. hypotension) and the need for postoperative respiratory support. Results No patients in group I developed any attacks of postoperative apnea, postoperative bradycardia, or hypoxia. On the contrary, 11 patients in group II and 16 patients in group III developed attacks of postoperative apnea and hypoxia and required postoperative respiratory support. Conclusion Spinal anesthesia without sedation is safe and effective for infraumbilical operations in ex-preterm neonates with short hospitalization.