Intraoperative bradycardia was significantly more frequent in infants during their first year of life (1.27%) compared to children in their third (0.65%) or fourth year (0.16%).
Cohort (n=7,979)
What is the frequency, morbidity, and risk factors for bradycardia during anesthesia in infants compared to older children?
Bradycardia during anesthesia is more frequent in infants than older children, carries substantial morbidity, and its risk is significantly reduced when a pediatric anesthesiologist is present.
BACKGROUND: The frequency and morbidity of bradycardia during anesthesia in infants are not well documented. This study sought to determine the frequency of bradycardia during anesthesia in infants (0 to 1 yr) compared to that in older children, describe causes and morbidity, and identify factors that influence its frequency. METHODS: Computerized information abstracted from 7,979 anesthetic records of patients ages 0-4 yr undergoing noncardiac surgery were examined for the presence or absence of intraoperative bradycardia. To study bradycardia in infants, 4,645 anesthetics in patients aged 0-1 yr were considered. Those with bradycardia to heart rates less than 100 beats/min were examined for causes, morbidity, and treatment of the bradycardia. For analysis of influencing factors, the frequency of bradycardia in infants was related to age, sex, race, ASA physical status, surgical site (body cavity), complexity (major or minor) and duration, type of primary anesthetist, type of supervising anesthesiologist, and anesthetic agents. Logistic regression was used to estimate the significance (P < 0.05) and odds ratios for each. RESULTS: The frequency of bradycardia was 1.27% in the 1st yr of life, but only 0.65% in the third and 0.16% in the 4th yr, a significant difference. Causes of bradycardia in infants included disease or surgery in 35%, the dose of inhalation agent in 35%, and hypoxemia in 22%. Morbidity included hypotension in 30%, asystole or ventricular fibrillation in 10%, and death in 8%. Treatment involved epinephrine in 30% and chest compression in 25%. Associated factors included an ASA physical status of 3-5 (vs. 1 or 2) and longer (vs. shorter) surgery. Bradycardia was less than half as likely when the supervising anesthesiologist was a member of the Pediatric Anesthesia Service as with other anesthesiologists (P < 0.001). CONCLUSIONS: Bradycardia is more frequent in infants undergoing anesthesia compared to older children and is associated with substantial morbidity. It is more likely in sicker infants undergoing prolonged surgery and less likely when a pediatric anesthesiologist is present.
Keenan et al. (Sun,) conducted a cohort in Undergoing noncardiac surgery (n=7,979). Anesthesia in infants (0-1 year) vs. Anesthesia in older children (3rd and 4th year) was evaluated on Intraoperative bradycardia. Intraoperative bradycardia was significantly more frequent in infants during their first year of life (1.27%) compared to children in their third (0.65%) or fourth year (0.16%).