Spinal anesthesia compared with general anesthesia for neonates with hypertrophic pyloric stenosis. A retrospective study.

Background: Studies of spinal anesthesia in children are limited to a reduced group of high-risk patients and it remains relatively underused compared with general anesthesia in this age group in most institutions. In our experience, spinal anesthesia appears to be a good alternative to general anesthesia during pyloromyotomy in neonates and infants.

Aims: The purpose of this study was to retrospectively evaluate respiratory morbidity of spinal anesthesia compared to general anesthesia in infants undergoing pyloromyotomy.

Methods: The University Hospital of Salamanca used spinal or general anesthesia on infants undergoing pyloromyotomy between 2003 and 2017. The primary outcome assessed was the prevalence of apnea. The second one was the prevalence of oxygen saturation below 95%. An analysis was performed using t test or Mann-Whitney U test for continuous variables, and Chi-square for categorical variables. Logistic regression was done to account for differences in demographic and clinical covariates.

Results: The study sample consisted of 68 infants and neonates undergoing pyloromyotomy (48 with spinal anesthesia and 20 with general anesthesia). There was a significant difference in apneic episodes after surgery between general (number/percentage = 5/20, 25%) and spinal (number/percentage = 0/48, 0%) groups. Absolute risk reduction is 25% (CI 95%: 6%-44%), P < .001.

Conclusion: Spinal anesthesia in neonates with hypertrophic pyloric stenosis undergoing pyloromyotomy was a viable alternative to general anesthesia, reducing the respiratory morbidity associated with the latter.