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Gas induction for pyloromyotomy
Author(s) -
Scrimgeour Gemma E.,
Leather Nicholas W.F.,
Perry Rachel S.,
Pappachan John V.,
Baldock Andrew J.
Publication year - 2015
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12633
Subject(s) - medicine , rapid sequence induction , pyloromyotomy , neuromuscular blockade , anesthesia , intubation , cricoid pressure , glottis , muscle relaxant , pulmonary aspiration , pyloric stenosis , airway , surgery , stomach , pylorus , larynx
Summary Background Infants with pyloric stenosis are considered to be at high risk of aspiration on induction of anesthesia. Traditionally, texts have recommended classic rapid sequence induction ( RSI ) or awake intubation ( AI ). AI has generally fallen out of favor, while the components of RSI have become increasingly controversial. Infants are at high risk of hypoxemia if ventilation is not maintained while waiting for neuromuscular blockade to establish. The efficacy of cricoid pressure ( CP ) to prevent aspiration has not been proven. It can impair visualization of the glottis and make intubation difficult. It is debatable whether any RSI technique is needed for pyloromyotomy. A recent review of 235 infants reported no aspiration events. These children were anesthetized with a variety of techniques, including RSI , gas induction, and AI . In our institution, we teach a gaseous induction. The nasogastric tube is used to empty the stomach and anesthesia is induced with sevoflurane. A nondepolarizing muscle relaxant is administered and ventilation maintained until neuromuscular blockade is established and intubating conditions are optimal. We report our experience of this technique. Method A retrospective medical notes review of all patients undergoing pyloromyotomy between 2005 and 2012. Results There were 269 patients (84.4% male, mean weight 3.74 kg ± 0.74). Two hundred and fifty‐two (93.7%) received gas inductions and 17 (6.3%) intravenous ( IV ) inductions. Two children received an RSI . No patient‐specific factors were identified to explain operator choice in those receiving IV inductions. There were no recorded aspiration events. Conclusion Gas induction can be considered for children undergoing pyloromyotomy.