Impact of spinal anesthesia for open pyloromyotomy on operating room time

Kachko, Ludmyla; Simhi, Eliahu; Freud, Enrique; Dlugy, Elena; Katz, Jacob

doi:10.1016/j.jpedsurg.2009.03.038

Cited by 30 publications

(14 citation statements)

References 30 publications

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“…3 Metabolic disturbances, hyperventilation, dehydration and the residual effect of neuromuscular blocking agents, inhalants and opioids used primarily during the anesthetic procedure 3 could increase the risk of central apnea, increased in preterm infants who constitute 12% of cases, 3 leading to respiratory problems that require longterm maintenance of mechanical ventilation. 2 Neonates are especially sensitive to the respiratory depressant effects associated with opioid analgesia. This sensitivity appears to be related to immaturity of the respiratory muscles and respiratory control centers.…”

Section: Discussionmentioning

confidence: 99%

“…4 Inhalational induction has been recommended due to its safety in pediatric patients. 2,4,6 In the neonatal period, the regional analgesia is indicated when our goal is an early extubation. Besides providing an adequate level of intraoperative analgesia and its longer duration in the postoperative period, 5 it provides a degree of muscle relaxation to facilitate the surgical technique.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided paravertebral block for pyloromyotomy in 3 neonates with congenital hypertrophic pyloric stenosis

Mata-Gómez

Guerrero-Domínguez

García-Santigosa

et al. 2015

Brazilian Journal of Anesthesiology (English Edition)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided paravertebral block for pyloromyotomy in 3 neonates with congenital hypertrophic pyloric stenosis

Mata-Gómez

Guerrero-Domínguez

García-Santigosa

et al. 2015

Brazilian Journal of Anesthesiology (English Edition)

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“…Several well‐conducted trials have demonstrated that once sufficient experience has been obtained, at least equivalent results to open pyloromyotomy may be achieved with potentially earlier introduction of enteral feeds and discharge . At the same time, recent concerns over the potential adverse neurodevelopmental outcomes seen in infants following surgical procedures requiring general anaesthesia, including pyloromyotomy, need to be carefully considered given the potential for performing open pyloromyotomy under regional anaesthesia …”

Section: Discussionmentioning

confidence: 99%

Infantile hypertrophic pyloric stenosis: Has anything changed?

Taylor

Cass

Holland

2012

J Paediatrics Child Health

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Aim:The study aims to review the contemporary presentation, diagnosis and treatment of children with infantile hypertrophic pyloric stenosis (IHPS) at an Australian paediatric tertiary centre. Methods: A retrospective case review of patients with IHPS presenting to our institution between January 2004 and December 2010 was performed. Results were compared with a previous study evaluating two earlier 6-year series of patients treated between January 1984 and November 1995. Results: Of 362 infants presenting over the current 7-year review, 84.8% were male. Mean age of admission fell from 5.9 weeks in the previous study to 5.4 weeks. An 'olive' was palpated on examination in 48%, visible peristalsis seen in 25% and 16% of patients presented with haematemesis. Diagnosis solely on clinical examination fell from 74% to 9% and was associated with a corresponding increase in use of ultrasound from 16% to 91%. The frequency of serum chloride values less than 85 mmol/L declined from 26% to 9%. A variety of open and minimally invasive surgical approaches were used with similar outcomes, although laparoscopic pyloromyotomy was associated with significantly higher rates of wound infection (c 2 = 4.6, P = 0.03). The frequency of major complications remained low at 1%. Conclusion: Contemporary patients with IHPS typically present earlier with a reduction in the incidence of metabolic derangement. Diagnosis based on clinical examination alone appears uncommon, with the majority of suspected cases confirmed by ultrasound. There was no clear difference in overall outcome based on the surgical approach used, although minor variations may reflect our institution's initial experience with laparoscopic pyloromyotomy.

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“…Additional studies should include an assessment of the potential for alternative anesthetic approaches, including spinal, epidural, and local anesthesia, to potentially ameliorate any associated adverse neurodevelopmental sequelae [27]. Potentially all infants that require GA for a surgical procedure may need to be enrolled in newborn developmental follow-up clinics.…”

Section: Limitations Of the Studymentioning

confidence: 99%