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PEDIATRIC ANESTHESIA

A Retrospective Examination of Regional Plus General Anesthesia in Children Undergoing Open Heart Surgery

Gregory B. Hammer, MD^*,, Khanh Ngo^§, and Alex Macario, MD, MBA^*,

Departments of *Anesthesia, Pediatrics, and Health Research and Policy, Stanford University Medical Center, Stanford, California; and §University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Address correspondence and reprint requests to Gregory B. Hammer, MD, Department of Anesthesia, Rm H3580, Stanford University Medical Center, 300 Pasteur Dr., Stanford, CA 94305-5115. Address e-mail to ham{at}leland.stanford.edu

The use of regional anesthesia in combination with general anesthesia for children undergoing cardiac surgery is receiving increasing attention from clinicians. The addition of regional anesthesia may improve clinical outcomes and decrease costs as a result of the reduced need for postoperative mechanical ventilation. The goal of this retrospective chart review was to evaluate whether spinal anesthesia (SAB) or epidural anesthesia (EPID) in combination with general anesthesia was associated with circulatory stability, satisfactory postoperative sedation/analgesia, and a low incidence of adverse effects. The medical records of 50 consecutive children having open heart surgery with SAB or EPID and general anesthesia between September 1996 and December 1997 were reviewed. We found no significant differences in the incidence of clinically significant changes in vital signs, oxygen desaturation, hypercarbia, or vomiting. Patients in the SAB group received significantly more sedative/analgesic interventions than those in the EPID group.

Implications: Techniques for combining regional and general anesthesia in children undergoing open heart surgery are described. Patients having spinal anesthesia may require more sedative/analgesic interventions postoperatively compared with those having epidural anesthesia. A prospective study with a larger sample size is required to determine other differences, including the incidence of postoperative vomiting.

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