[Anesthesia in hypertrophic pyloric stenosis]

Abstract

Hypertrophic pyloric stenosis is one of the most common gastrointestinal abnormalities occurring in the first six months of life. It is a medical emergency and surgical therapy is considered only after correction of fluid and electrolyte deficits. Careful preoperative therapy to correct deficits may require several days to ensure safe general anaesthesia and surgery. The anaesthetic management of 58 consecutive infants (51 male, 7 female) with congenital hypertrophic pyloric stenosis over a 4-year period is reviewed. Mean age was 39.5 days (range 13-100), mean weight was 3.95 kg (range 2.4-5.3). Elective Ramstadt's fibromyotomy was performed after water-electrolyte balance restoration. Inhalation induction was made and oro-tracheal intubation achieved with succinylcholine 1.5 mg/kg-1. General anaesthesia was performed without complications. All patients were discharged during the period between the 2nd and 7th day after surgery, except one who was discharged after 16 days because of dehiscence of the surgical wall. Preoperative preparation is the primary factor contributing to the low perioperative complication rates, and the necessity to recognize fluid and electrolyte imbalance is the key for a successful anaesthetic management.