Epidurals, Ethics, and Expectations: Talking Risks and Benefits in Obstetric Anesthesia

Preterm infants who are < 50-60 weeks postconceptual age at the time of surgery are at increased risk for postoperative episodes of apnea. Risk factors for postanesthetic apnea include prematurity, anemia, hypothermia, sepsis and previous history of apneic episodes. Elective surgery should be delayed until at least 60 weeks postconceptual age. A recent study by Davidson and colleagues focuses on the anesthetic care of young infants who require elective inguinal herniorrhaphy, done under either general anesthesia or regional anesthesia. Despite dramatic improvements in monitoring and shorter-acting anesthetics the risk for apnea in young infants and former premature babies has not really changed. The risk for apnea is present in the PACU but also may not become apparent until later in the postoperative course, even as long as 6-8 hours later (on the ward).