A Delphi Analysis to Reach Consensus on Preoperative Care in Infants with Hypertrophic Pyloric Stenosis

Eur J Pediatr Surg DOI: 10.1055/s-0039-3401987 Introduction Infantile hypertrophic pyloric stenosis (IHPS) is a common gastrointestinal condition that can lead to metabolic alkalosis and, if uncorrected, to respiratory complications. A standardized approach to correct metabolic derangements and dehydration may reduce time until pyloromyotomy while preventing potential respiratory complications. Such an evidence-based policy regarding preoperative care is absent. We aim to formulate a recommendation about preoperative care for infants with IHPS using the Delphi technique. Materials and Methods The RAND/UCLA appropriateness method was used to reach international consensus in a panel of pediatric surgeons, pediatric anesthetists, and pediatricians. Statements on type and frequency of blood sampling, required serum concentrations before pyloromyotomy and intravenous fluid therapy, were rated online using a 9-point Likert scale. Consensus was present if the panel rated the statement appropriate/obligatory (panel median: 7–9) or inappropriate/unnecessary (panel median: 1–3) without disagreement according to the interpercentile range adjusted for symmetry formula. Results Thirty-three and twenty-nine panel members completed the first and second round, respectively. Consensus was reached in 54/74 statements (73%). The panel recommended the following laboratory tests and corresponding cutoff values prior to pyloromyotomy: pH ≤7.45, base excess &l...
Source: European Journal of Pediatric Surgery - Category: Surgery Authors: Tags: Original Article Source Type: research

Related Links:

Publication date: Available online 25 January 2020Source: Anaesthesia &Intensive Care MedicineAuthor(s): Graham Knottenbelt, Amanda DaltonAbstractSpecialist surgery in infancy provides challenges for paediatric anaesthetists. There is growing appreciation that the relatively higher rate of severe critical events in infants during the perioperative period requires appropriate competence, experience and resources for the safe conduct of anaesthesia. Both common (inguinal hernias and hypertrophic pyloric stenosis) and less common conditions (tracheo-oesophageal fistula, congenital diaphragmatic hernia, exomphalos, gastros...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
Abstract BACKGROUND: Pyloromyotomy is one of the most common surgical procedures performed on otherwise healthy infants. Pyloric stenosis results in a hypochloremic, hypokalemic metabolic alkalosis that is considered a medical emergency. This alkalotic state is believed to be associated with an increased incidence of apneic episodes. Because apnea tends to occur during anesthetic emergence, we sought to examine the association between the preoperative serum bicarbonate level and anesthetic emergence time after laparoscopic pyloromyotomy. METHODS: Data were collected from patients who underwent laparoscopic py...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Vaquero Roncero LM, Rodríguez López JM Abstract BACKGROUND: Studies of spinal anesthesia in children are limited to a reduced group of high-risk patients and it remains relatively underused compared with general anesthesia in this age group in most institutions. In our experience, spinal anesthesia appears to be a good alternative to general anesthesia during pyloromyotomy in neonates and infants. AIMS: The purpose of this study was to retrospectively evaluate respiratory morbidity of spinal anesthesia compared to general anesthesia in infants undergoing pyloromyotomy. METHODS: The Univers...
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
Conclusion The use of succinylcholine, cisatracurium, or no NMBA at induction of anesthesia in infants undergoing laparoscopic pyloromyotomy had no statistically significant effect on time until extubation and complication rates. A modified RSI seems to be safe and effective in these cases. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: European Journal of Pediatric Surgery - Category: Surgery Authors: Tags: Original Article Source Type: research
Eur J Pediatr Surg DOI: 10.1055/s-0038-1637016Pyloromyotomy is the tried and tested surgical procedure for successful operative treatment of pyloric stenosis. Over time, the operative approach has evolved to take advantage of cosmetically superior incisions and more recently minimally invasive surgery. During and following surgery, complications are uncommon. The specific complications of an inadequate pyloromyotomy requiring repeated procedure and mucosal perforation during an overzealous pyloromyotomy represent the ends of a spectrum within which sits the perfect procedure. Here, we discuss these specific complications t...
Source: European Journal of Pediatric Surgery - Category: Surgery Authors: Tags: Review Article Source Type: research
Considerable variation in the perioperative management of infants with pyloric stenosis (PS) led the authors to undertake a survey of pediatric anesthesiologists to determine if consensus-based guidelines could be developed.
Source: Journal of Surgical Research - Category: Surgery Authors: Source Type: research
Eur J Pediatr Surg DOI: 10.1055/s-0037-1604116 Introduction Several authors have reported the use of atropine as an alternative treatment to pyloromyotomy in infants with hypertrophic pyloric stenosis (HPS). Our aims were to review the efficacy of atropine in treating HPS and to compare atropine therapy versus pyloromyotomy. Materials and Methods Using a defined search strategy (PubMed, MEDLINE, OVID, Embase, Cochrane databases), two investigators independently identified studies reporting the use of atropine for HPS. Case reports and opinion articles were excluded. Outcome measures included success rate, s...
Source: European Journal of Pediatric Surgery - Category: Surgery Authors: Tags: Review Article Source Type: research
Changing patterns of referral and management of hypertrophic pyloric stenosis (HPS) in North America have recently been described. Comfort with perioperative management, anesthesia, and corrective surgery have been cited as reasons for these changes. Our primary objective was to assess pyloromyotomy outcomes between different hospital types across Canada. The secondary objective was to geospatially map all pyloromyotomies to identify regions of higher HPS incidence across Canada.
Source: Journal of Pediatric Surgery - Category: Surgery Authors: Source Type: research
Publication date: Available online 26 December 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Amanda Dalton, Graham Knottenbelt Specialist surgery in infancy provides unique and significant challenges for paediatric anaesthetists. Both common (inguinal hernias and hypertrophic pyloric stenosis) and less common conditions (tracheo-oesophageal fistula, congenital diaphragmatic hernia, exomphalos (omphalocele), gastroschisis and congenital lobar emphysema) require a sound understanding of the relevant pathology and the particular issues that may be encountered in order to safely anaesthetise these infants. ...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
CONCLUSION: Our study supports the current literature demonstrating improved outcomes, shorter overall LOS and decreased risk of complications when infants with HPS are treated in pediatric centres. This should be considered when planning access to pediatric surgical resources. PMID: 27669400 [PubMed - as supplied by publisher]
Source: Canadian Journal of Surgery - Category: Surgery Authors: Tags: Can J Surg Source Type: research
More News: Anesthesia | Anesthesiology | Chloride | Correction of Pyloric and Duodenal Stenosis | Gastroenterology | Laboratory Medicine | Pediatrics | Potassium | Pyloric Stenosis | Respiratory Medicine | Sodium | Surgery