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October 27, 2015
1:00:00 PM - 3:00:00 PM
Room Hall B2-Area D
Pyloromyotomy and Anesthesia in Infants: Make It Easy
giorgio ivani, Ph.D., Valeria Mossetti, M.D., Anca Balintescu, M.D., Rodolfo Lio, Student, Alessia Cerrina, M.D., Riccardo Guanà, M.D.
Regina Margherita Children Hospital, torino, Italy
Disclosures: G. ivani: None. V. Mossetti: None. A. Balintescu: None. R. Lio: None. A. Cerrina: None. R. Guanà: None.
Introduction: Pyloromyotomy for hypertrophic pyloric stenosis (HPS) is an infant surgical procedure requiring pediatric anesthesiological skill to offer a good perioperative pain control. Inhalation anesthesia and intubation are commonly used for induction and maintenance but different methods of analgesia are described, all of them with drawbacks: respiratory depression and PONV for intravenous opioids, short duration of intrathecal anesthesia, mainly for postoperative pain relief, the TAP block.

Methods: After Internal Review Board approval, we recorded the HPS surgey from December 2009 to February 2015 in our hospital. Traditional Fredet-Ramsted open technique (right upper quadrant abdominal incision and extramucosa pyloromiotomy) was the surgical procedure used for the first 4 years, and the three-acces laparoscopic approach in the last two years. Anesthesiological management was: sevoflurane induction followed by a caudal block in lateral position with 0,2% ropivacaine, 1ml/kg maintaining the spontaneous breathing; then nasal intubation without musclerelaxant. Intravenous acetaminophen (7.5 mg/kg) was administered at the end of surgery and then 3 times a day if necessary. Intraoperative rescue dose of fentanyl (1mcg/kg) was administered if block didn't appear to be effective (haemodynamic changes with increasing heart rate and blood pressure and pain awakening score > 4).

Results: We recorded 239 cases, mean age 35 days with a median of 42 days (range 20 days - 3 months); mean weight was 3,5 kg with a median of 3 kg (2,2 - 6 kg). Only 4 patients out of 227 of the open technique group needed intraoperative opioid rescue, in all the other patients dermatomal level of analgesia was sufficient. In the 12 patients of the laparoscopic approach, 5 needed intraoperative rescue. The infants were sent to the ward and received oral feeding 8 to 12 hours after surgery. Mean postoperative discharge days were 4 days (range 3-8 days).

Conclusions: Inhalation anesthesia with sevoflurane and caudal block as sole analgesic technique in our experience appeared to be simple and safe in the anesthesiological management of pyloromyotomy for HPS in infants

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