Spinal anesthesia for noncardiac surgery in infants with congenital heart diseases

Objective/Aim: To compare hemodynamic parameters in infants with congenital heart disease (CHD) undergoing noncardiac surgery (NCS) under awake spinal anesthesia (SA) with controls without CHD also undergoing SA. Background: NCS poses a twofold higher mortality risk in infants with CHD. SA might be a good alternative to general anesthesia (GA) in this setting. Methods: The files of 84 infants were reviewed; 42 had CHD and 42 were controls without CHD. Primary outcome measures were percent decrease in mean arterial pressure (%MAPdecrease) and heart rate (%HRdecrease) from baseline to the lowest intraoperative value. One-way analysis of variance (anova), anova with repeated measures, Pearson chi-square test, Fishers exact test, and Pearson correlation were used for statistical analysis. Time to discharge was analyzed with the nonparametric MannWhitney U-test. Results: There were no significant between-group differences in %MAPdecrease and %HRdecrease; no significant associations and correlations between %MAPdecrease or %HRdecrease and other variables; and no correlation between %MAPdecrease and %HRdecrease. A %MAPdecrease of >20% was documented in 11 patients with CHD (26.2%) and 10 controls (23.8%); a lowest intraoperative HR of <100 b center dot min-1 was recorded in two study patients (4.8%) and four controls (9.5%) (P = NS for both). There were no cases of high SA or conversion to GA and no need for mechanical ventilation or inotropic support intra/postoperatively. Conclusions: These preliminary findings show that hemodynamic parameters in infants with CHD undergoing NCS under awake SA are not different from controls without CHD and that SA appears to be safe in infants with CHD.