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Abstract：
Recently, there has been significant focus on the effects of anesthesia on the developing brain. Concern is heightened in children <3 years of age requiring lengthy and/or multiple anesthetics. Hypospadias correction is common in otherwise healthy children and may require both lengthy and repeated anesthetics. At academic centers, many of these cases are performed with the assistance of anesthesia and surgical trainees. We sought to identify both the incidence of these children undergoing additional anesthetics before age 3 as well as to understand the effect of trainees on duration of surgery and anesthesia and thus anesthetic exposure (AE), specifically focusing on those cases >3 hours.
We analyzed all cases of hypospadias repair from December 2011 through December 2018 at Texas Children\'s Hospital. In all, 1326 patients undergoing isolated hypospadias repair were analyzed for anesthesia time, surgical time, provider types involved, AE, caudal block, and additional AE related/unrelated to hypospadias.
For the primary aim, a total of 1573 anesthetics were performed in children <3 years of age, including 1241 hypospadias repairs of which 1104 (89%) were completed with <3 hours of AE. For patients with <3 hours of AE, 86.1% had a single surgical intervention for hypospadias. Of patients <3 years of age, 17.3% required additional nonrelated surgeries. There was no difference in anesthesia time in cases performed solely by anesthesia attendings versus those performed with trainees/assistance (16.8 vs 16.8 minutes; P = .98). With regard to surgery, cases performed with surgical trainees were of longer duration than those performed solely by surgical attendings (83.5 vs 98.3 minutes; P < .001). Performance of surgery solely by attending surgeon resulted in a reduced total AE in minimal alveolar concentration (MAC) hours when compared to procedures done with trainees (1.92 vs 2.18; P < .001). Finally, comparison of patients undergoing initial correction of hypospadias with subsequent revisions revealed a longer time (117.7 vs 132.2 minutes; P < .001) and AE during the primary stage.
The majority of children with hypospadias were repaired within a single AE. In general, most children did not require repeated AE before age 3. While presence of nonattending surgeons was associated with an increase in AE, this might at least partially be due to differences in case complexity. Moreover, the increase is likely not clinically significant. While it is critical to maintain a training environment, attempts to minimize AE are crucial. This information facilitates parental consent, particularly with regard to anesthesia duration and the need for additional anesthetics in hypospadias and nonhypospadias surgeries.
We analyzed all cases of hypospadias repair from December 2011 through December 2018 at Texas Children\'s Hospital. In all, 1326 patients undergoing isolated hypospadias repair were analyzed for anesthesia time, surgical time, provider types involved, AE, caudal block, and additional AE related/unrelated to hypospadias.
For the primary aim, a total of 1573 anesthetics were performed in children <3 years of age, including 1241 hypospadias repairs of which 1104 (89%) were completed with <3 hours of AE. For patients with <3 hours of AE, 86.1% had a single surgical intervention for hypospadias. Of patients <3 years of age, 17.3% required additional nonrelated surgeries. There was no difference in anesthesia time in cases performed solely by anesthesia attendings versus those performed with trainees/assistance (16.8 vs 16.8 minutes; P = .98). With regard to surgery, cases performed with surgical trainees were of longer duration than those performed solely by surgical attendings (83.5 vs 98.3 minutes; P < .001). Performance of surgery solely by attending surgeon resulted in a reduced total AE in minimal alveolar concentration (MAC) hours when compared to procedures done with trainees (1.92 vs 2.18; P < .001). Finally, comparison of patients undergoing initial correction of hypospadias with subsequent revisions revealed a longer time (117.7 vs 132.2 minutes; P < .001) and AE during the primary stage.
The majority of children with hypospadias were repaired within a single AE. In general, most children did not require repeated AE before age 3. While presence of nonattending surgeons was associated with an increase in AE, this might at least partially be due to differences in case complexity. Moreover, the increase is likely not clinically significant. While it is critical to maintain a training environment, attempts to minimize AE are crucial. This information facilitates parental consent, particularly with regard to anesthesia duration and the need for additional anesthetics in hypospadias and nonhypospadias surgeries.
摘要：
最近,麻醉对发育中的大脑的影响一直受到关注。需要长时间和/或多种麻醉剂的3岁以下儿童的担忧加剧。尿道下裂矫正在其他健康的儿童中很常见，可能需要长时间和反复的麻醉剂。在学术中心，其中许多病例是在麻醉和外科学员的协助下进行的。我们试图确定这些儿童在3岁之前接受额外麻醉药的发生率，以及了解受训者对手术和麻醉持续时间以及麻醉药暴露（AE）的影响。特别关注那些>3小时的病例。
我们分析了2011年12月至2018年12月在德州儿童医院进行尿道下裂修复的所有病例。总之,分析1326例单纯性尿道下裂修复术患者的麻醉时间，手术时间,涉及的提供者类型，AE,尾部阻滞,以及与尿道下裂相关/无关的其他AE。
对于主要目标，在<3岁的儿童中总共进行了1573次麻醉药，包括1241例尿道下裂修复，其中1104例（89%）完成，AE<3小时。对于AE<3小时的患者，86.1％的人对尿道下裂进行了一次手术干预。在<3岁的患者中，17.3%需要额外的非相关手术。仅由麻醉医师进行的麻醉时间与由受训者/协助进行的麻醉时间没有差异（16.8vs16.8分钟；P=.98）。关于手术，由手术受训者进行的病例比仅由手术看诊者进行的病例持续时间更长(83.5vs98.3分钟;P<.001).与受训者进行的手术相比，仅由主治医生进行的手术可减少最小肺泡浓度（MAC）小时的总AE（1.92vs2.18；P<.001）。最后,对接受尿道下裂初始矫正和后续修正的患者进行比较,发现在初期阶段有更长的时间(117.7vs132.2分钟;P<.001)和AE.
大多数尿道下裂患儿在一次AE内得到修复。总的来说,大多数儿童在3岁之前不需要重复AE.虽然非主治医生的存在与AE的增加有关，这可能至少部分是由于案件复杂性的差异。此外，增加可能没有临床意义.虽然保持培训环境至关重要，尽量减少AE是至关重要的。这些信息有助于父母同意，特别是在尿道下裂和非尿道下裂手术中麻醉持续时间和需要额外的麻醉药方面。
我们分析了2011年12月至2018年12月在德州儿童医院进行尿道下裂修复的所有病例。总之,分析1326例单纯性尿道下裂修复术患者的麻醉时间，手术时间,涉及的提供者类型，AE,尾部阻滞,以及与尿道下裂相关/无关的其他AE。
对于主要目标，在<3岁的儿童中总共进行了1573次麻醉药，包括1241例尿道下裂修复，其中1104例（89%）完成，AE<3小时。对于AE<3小时的患者，86.1％的人对尿道下裂进行了一次手术干预。在<3岁的患者中，17.3%需要额外的非相关手术。仅由麻醉医师进行的麻醉时间与由受训者/协助进行的麻醉时间没有差异（16.8vs16.8分钟；P=.98）。关于手术，由手术受训者进行的病例比仅由手术看诊者进行的病例持续时间更长(83.5vs98.3分钟;P<.001).与受训者进行的手术相比，仅由主治医生进行的手术可减少最小肺泡浓度（MAC）小时的总AE（1.92vs2.18；P<.001）。最后,对接受尿道下裂初始矫正和后续修正的患者进行比较,发现在初期阶段有更长的时间(117.7vs132.2分钟;P<.001)和AE.
大多数尿道下裂患儿在一次AE内得到修复。总的来说,大多数儿童在3岁之前不需要重复AE.虽然非主治医生的存在与AE的增加有关，这可能至少部分是由于案件复杂性的差异。此外，增加可能没有临床意义.虽然保持培训环境至关重要，尽量减少AE是至关重要的。这些信息有助于父母同意，特别是在尿道下裂和非尿道下裂手术中麻醉持续时间和需要额外的麻醉药方面。
