Pyloric Stenosis

Abstract

Pyloric stenosis is one of the most common surgical conditions affecting neonates and young infants. Hypertrophy of the pyloric muscular layers results in gradual gastric outlet obstruction. Persistent episodic projectile vomiting and dehydration as well as hypochloremic, hypokalemic metabolic alkalosis are cardinal features. Definitive treatment is surgical pyloromyotomy, but it is not a surgical emergency. Emergency medical intervention is often required to correct intravascular volume depletion and electrolyte disturbances. Morbidity and mortality should be limited due to advancements in surgical and perioperative care. Morbidity can occur due to poor preoperative resuscitation, anesthetic management difficulties, or postoperative complications. The following manuscript is a review of current evidence-based perioperative care of infants with pyloric stenosis. It reviews the pathophysiology that results in metabolic disturbances and intravascular volume depletion. It focuses on preoperative assessment and correction of electrolyte abnormalities and anesthetic technique including airway management and postoperative analgesia.