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Canadian Journal of Anaesthesia

, Volume 38, Issue 5, pp 668–676 | Cite as

Pyloric stenosis

  • Bruno Bissonnette
  • Patrick J. Sullivan
Continuing Medical Education

Abstract

Infantile pyloric stenosis is the most frequently encountered infant gastrointestinal obstruction in most general hospitals. Although the primary therapy for pyloric stenosis is surgical, it is essential to realize that pyloric stenosis is a medical and not a surgical emergency. 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 to successful anaesthetic management. Careful preoperative therapy to correct severe deficits may require several days to ensure safe anaesthesia and surgery. The anaesthetic records of 100 infants with pyloric stenosis were reviewed. Eighty-five per cent of the infants were male (i.e., 5.7:1 male to female ratio) 12% were prematures. Surgical correction was undertaken at an average age of 5.6 wk, and the average weight of the infants at the time of surgery was 4 kg. A clinical diagnosis of pyloric stenosis by history and physical examination alone was made in 73% of the infants presenting to The Hospital for Sick Children. All the infants received general anaesthesia for the surgical procedure and there were no perioperative deaths.

Key words

acid-base equilibrium: acidosis, alkalosis, metabolic anaesthesia: paediatric fluid balance: electrolites, ions intubation: technique surgery: paediatric, pyloric stenosis 

Résumé

La sténose pylorique demeure la principale cause d’obstruction intestinale survenant chez les bébés. Même si son traitement ultime doit être chirurgical, elle represente d’abord une urgence médicale. Une réanimation préopératoire adéquate est nécessaire afin de prévenir les complications périopératoires et la reconnaissance par l’anesthésiste des perturbations hydroélectrolytiques en est la clef. Il faut souvent passer plusieurs jours à corriger les déficits les plus importants afin d’assurer le succès de l’intervention. Nous avons revu 100 dossiers anesthésiques de pyloromyotomie. On y retrouvait 85% de garçons et 12% de prématurés. L’intervention survenait vers l’âge de 5.6 semaines alors que l’enfant pesait en moyenne 4 kg. Dans 73% des cas, on avait posé le diagnostic sur la base de l’anamnèse et de l’examen physique seulement. On a employé une anesthésie générate dans tous les cas et nous n’avons eu à déplorer aucun décès périopératoire.

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Copyright information

© Canadian Anesthesiologists 1991

Authors and Affiliations

  • Bruno Bissonnette
    • 1
  • Patrick J. Sullivan
    • 1
  1. 1.Department of AnaesthesiaThe Hospital for Sick Children, University of TorontoToronto

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