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Observational Study
. 2023 Jul 13;18(7):e0288431.
doi: 10.1371/journal.pone.0288431. eCollection 2023.

Sex differences in pediatric caudal epidural anesthesia under sedation without primary airway instrumentation

Philipp Opfermann  1 , Werner Schmid  1 , Mina Obradovic  1 , Felix Kraft  1 , Markus Zadrazil  1 , Daniela Marhofer  1 , Peter Marhofer  1
Affiliations
Observational Study

Sex differences in pediatric caudal epidural anesthesia under sedation without primary airway instrumentation

Philipp Opfermann et al. PLoS One. .

Abstract

Study objective: To identify sex differences associated with caudal epidurals, the most commonly used technique of pediatric regional anesthesia, based on individually validated data of ultrasound-guided blocks performed between 04/2014 and 12/2020.

Methods: Prospectively collected and individually validated data of a cohort of children aged between 0-15 years was analyzed in a retrospective observational study. We included pediatric surgeries involving a primary plan of caudal epidural anesthesia under sedation (without airway instrumentation) and a contingency plan of general anesthesia. Sex-specific rates were analyzed for overall failure of the primary anesthesia plan, for residual pain, for block-related technical complications and for critical respiratory events. We used Fisher´s exact tests and multivariable logistic regressions were used to evaluate sex-specific associations.

Results: Data from 487 girls and 2060 boys ≤15 years old (ASA status 1 to 4) were analyzed. The primary-anesthesia-plan failure rate was 5.5% (95%CI 3.8%-7.8%) (N = 27/487) among girls and 4.7% (95%CI 3.9%-5.7%) (N = 97/2060) among boys (p = 0.41). Residual pain was the main cause of failure, with rates of 4.5% (95%CI 2.9-6.6%) (N = 22/487) among girls and 3.0% (95%CI 2.3-3.8%) (N = 61/2060) among boys (p = 0.089). Block-related technical complications were seen at rates of 0.8% (95%CI 0.3%-1.9%) (N = 4/487) among girls vs 2.5% (95%CI 0.5-2.7%) (N = 51/2060) among boys and, hence, significantly more often among male patients (p = 0.023). Male sex was significantly associated with higher odds (adjusted OR: 3.18; 95% CI: 1.12-9; p = 0.029) for such technical complications regardless of age, ASA status, gestational week at birth or puncture attempts. Critical respiratory events occurred at a 1.7% (95%CI 1.2%-2.3%) rate (N = 35/2060) twice as high among boys as 0.8% (95%CI 0.3%-1.9%) (N = 4/487) among girls (p = 0.21).

Conclusions: While the the primary-anesthesia-plan failure rate was equal for girls and boys, technical complications and respiratory events are more likely to occur in boys.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart illustrating the roadmap of database interrogation for this study (GA general anesthesia).
Fig 2
Fig 2. Bar graph of any block-related technical complications in boys versus girls.
*Combined endpoint of blood aspiration, dura puncture with „high spinal“, anatomical impediments, primary unnoticed subcutaneous LA injection; ‡ Fisher’s exact test. Given are absolute numbers and percentages including 95% binomial confidence interval (CI) for the total sex-specific rates.
Fig 3
Fig 3. Specific block-related technical complications in 2060 boys and 487 girls.
Given are absolute numbers and percentages including 95% binomial confidence interval (CI) for the total sex-specific rates.
Fig 4
Fig 4. Bar graph of any critical respiratory events in 2060 boys and 487 girls.
Given are absolute numbers and percentages including 95% binomial confidence interval (CI) for the total sex-specific rates.
See this image and copyright information in PMC

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