The postoperative occurrence of cardio-respiratory adverse events in small infants undergoing gastrointestinal surgery: a prospective comparison of general anesthesia and combined spinal-epidural anesthesia.

INTRODUCTION: This study was designed to compare the occurrences of postoperative cardio-respiratory adverse events during an 8-day follow-up period in the neonatal intensive care unit in small infants who underwent elective gastrointestinal surgery under general and combined spinal epidural anesthesia.

METHODS: Fifty infants who underwent elective primary gastrointestinal surgery were randomly divided into two anesthetic techniques. General anesthesia (25 patients) and combined spinal-epidural anesthesia (25 patients). The frequency and types of postoperative cardiovascular and respiratory adverse events in the two groups were recorded and compared during an 8-day follow-up period in the neonatal intensive care unit.

RESULTS: The total number of postoperative respiratory adverse events and the number of infants who experienced at least one respiratory adverse event were statistically more in infants anesthetised by general anesthesia than in infants who were anesthetised by combined spinal-epidural anesthesia, respectively (p < 0.0001) and (RR = 2.5; 95% CI 1.2-5.3). There were significantly more cardiovascular adverse events in the general anesthesia infants than in the combined spinal-epidural anesthesia (p = 0.005). These adverse cardiovascular events were also more resistant to treatment in the general anesthesia infants than in the combined spinal-epidural anesthesia infants (p = 0.001).

CONCLUSION: Compared to general anesthesia, combined spinal-epidural anesthesia reduces the frequency of postoperative respiratory adverse events and improves the postoperative cardiovascular stability in small infants who undergo elective gastrointestinal surgery.