TY - JOUR
T1 - Differences in Blood Pressure in Infants after General Anesthesia Compared to Awake Regional Anesthesia (GAS Study - A Prospective Randomized Trial)
AU - McCANN, M.E.
AU - Withington, Davinia E.
AU - Arnup, Sarah J.
AU - Davidson, Andrew J.
AU - DISMA, N.
AU - FRAWLEY, G.
AU - Morton, Neil S.
AU - BELL, G.
AU - Hunt, Rodney W.
AU - Bellinger, David C
AU - Polaner, D. M.
AU - Leo-Macias, Alejandra
AU - Absalom, Anthony R.
AU - Von Ungern-Sternberg, Britta S.
AU - Izzo, Francesca
AU - Szmuk, Peter
AU - Young, Vanessa
AU - Soriano, S. G.
AU - De Graaff, J. C.
N1 - Funding Information:
Funding: All hospitals and centers were generously supported by anesthesiology departmental funding. In addition to this funding, specific grants received for this study are as follows: Australia and New Zealand: The Australian National Health & Medical Research Council, Canberra, Australian Capital Territory, Australia; Australian and New Zealand College of Anaesthetists, Melbourne, Victoria, Australia; Murdoch Children’s Research Institute, Melbourne, Victoria, Australia. This study was supported by the Victorian Government’s Operational Infrastructure Support Program in Melbourne, Victoria, Australia; Department of Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne, Victoria, Australia; Department of Anaesthesia, Monash Medical Centre, Melbourne, Victoria, Australia; Department of Anaesthesia and Pain Management, Princess Margaret Hospital Foundation, Perth, Western Australia, Australia; Department of Paediatric Anaesthesia, Women’s Children’s Hospital, Adelaide, South Australia, Australia, and
Publisher Copyright:
Copyright © 2017 International Anesthesia Research Society.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - BACKGROUND: The General Anesthesia compared to Spinal anesthesia (GAS) study is a prospective randomized, controlled, multisite, trial designed to assess the influence of general anesthesia (GA) on neurodevelopment at 5 years of age. A secondary aim obtained from the blood pressure data of the GAS trial is to compare rates of intraoperative hypotension after anesthesia and to identify risk factors for intraoperative hypotension. METHODS: A total of 722 infants ≤60 weeks postmenstrual age undergoing inguinal herniorrhaphy were randomized to either bupivacaine regional anesthesia (RA) or sevoflurane GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born at <26 weeks of gestation. Moderate hypotension was defined as mean arterial pressure measurement of <35 mm Hg. Any hypotension was defined as mean arterial pressure of <45 mm Hg. Epochs were defined as 5-minute measurement periods. The primary outcome was any measured hypotension <35 mm Hg from start of anesthesia to leaving the operating room. This analysis is reported primarily as intention to treat (ITT) and secondarily as per protocol. RESULTS: The relative risk of GA compared with RA predicting any measured hypotension of <35 mm Hg from the start of anesthesia to leaving the operating room was 2.8 (confidence interval [CI], 2.0-4.1; P <.001) by ITT analysis and 4.5 (CI, 2.7-7.4, P <.001) as per protocol analysis. In the GA group, 87% and 49%, and in the RA group, 41% and 16%, exhibited any or moderate hypotension by ITT, respectively. In multivariable modeling, group assignment (GA versus RA), weight at the time of surgery, and minimal intraoperative temperature were risk factors for hypotension. Interventions for hypotension occurred more commonly in the GA group compared with the RA group (relative risk, 2.8, 95% CI, 1.7-4.4 by ITT). CONCLUSIONS: RA reduces the incidence of hypotension and the chance of intervention to treat it compared with sevoflurane anesthesia in young infants undergoing inguinal hernia repair.
AB - BACKGROUND: The General Anesthesia compared to Spinal anesthesia (GAS) study is a prospective randomized, controlled, multisite, trial designed to assess the influence of general anesthesia (GA) on neurodevelopment at 5 years of age. A secondary aim obtained from the blood pressure data of the GAS trial is to compare rates of intraoperative hypotension after anesthesia and to identify risk factors for intraoperative hypotension. METHODS: A total of 722 infants ≤60 weeks postmenstrual age undergoing inguinal herniorrhaphy were randomized to either bupivacaine regional anesthesia (RA) or sevoflurane GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born at <26 weeks of gestation. Moderate hypotension was defined as mean arterial pressure measurement of <35 mm Hg. Any hypotension was defined as mean arterial pressure of <45 mm Hg. Epochs were defined as 5-minute measurement periods. The primary outcome was any measured hypotension <35 mm Hg from start of anesthesia to leaving the operating room. This analysis is reported primarily as intention to treat (ITT) and secondarily as per protocol. RESULTS: The relative risk of GA compared with RA predicting any measured hypotension of <35 mm Hg from the start of anesthesia to leaving the operating room was 2.8 (confidence interval [CI], 2.0-4.1; P <.001) by ITT analysis and 4.5 (CI, 2.7-7.4, P <.001) as per protocol analysis. In the GA group, 87% and 49%, and in the RA group, 41% and 16%, exhibited any or moderate hypotension by ITT, respectively. In multivariable modeling, group assignment (GA versus RA), weight at the time of surgery, and minimal intraoperative temperature were risk factors for hypotension. Interventions for hypotension occurred more commonly in the GA group compared with the RA group (relative risk, 2.8, 95% CI, 1.7-4.4 by ITT). CONCLUSIONS: RA reduces the incidence of hypotension and the chance of intervention to treat it compared with sevoflurane anesthesia in young infants undergoing inguinal hernia repair.
UR - http://www.scopus.com/inward/record.url?scp=85029560596&partnerID=8YFLogxK
U2 - 10.1213/ANE.0000000000001870
DO - 10.1213/ANE.0000000000001870
M3 - Article
C2 - 28489641
AN - SCOPUS:85029560596
SN - 0003-2999
VL - 125
SP - 837
EP - 845
JO - Anesthesia and Analgesia
JF - Anesthesia and Analgesia
IS - 3
ER -