9. Pyloric Stenosis Flashcards
What is it
Sequelae
Congenital hypertrophy
Circular and longitudinal muscles
Around pylorus of stomach
Oedema of mucosa
Passage of gastric content thru duodenum is blocked
classical non bilious projective vomiting
PS frequency
1/400 live births
M>F
1 born males
prem infants
x15 times more likely if parent had it
?need to transfer to hospital w/ PICU
Where to be done
Caseload reasonable amount of children requiring surgery of age group
surgeon anaesthetist ward theatre appropriate traiing / experience
Preop preparation
assessment
Standard hx exam consent / notes rv
If prem <37/40 PCA
Consider tf specialist centre
- Apnoea / hypoglycaemia more likely
Assoc abnormal include Pierre Robin sequence
- possibility difficult airway
Informed consent
Electively perform surgery fluid and electrolyte abnormality corrected
Preop Resus
Keep NPO
IV access & IV fluids
Insert NG - Free drain & aspirate
Assess dehydration
Fontanelle / Sunken eyes / CRT
If severe give bolus 20ml/kg 0.9%NaCl reassess
Correct dehydration / Met alkalosis / electrolyte abnormalities over 24 hours using NaCl w/ K supplementation where possible
PeriOp Management
Induction in warm operating .
avoiding need to disconnect and transfer
Ensure gastric emptying w/ 4 quadrant aspiration NG
Consider antisialogogue (atropine 20mcg/kg)
Debate around RSI and cricoid if gastric emptying complete
Induction option
RSI
Thio 4-5mg/kg & Sux 2mg/kg
Some prefer gas induction and then NMBA
ETT uncuffed 3/3.5 or micro cuff
Mangement under GA
IPPV air o2 volatile maint
Temp control
monitor & maintain
warm fluids
underbody heating
Abx as per local guideline
Analgesia 30mg/kg paracetamol
LA infiltration
0.8ml/kg .25 levo
Post op
Reversal muscle relaxant
(old doses neostigmine 50mcg/kg & glyco 10mcg/kg)
Extubate left lateral & fully awake
Post op analgesia
15mg/kg paracetamol up to 60mg/kg/24h
Monitoring including apnoea monitor
Post feeding per unit guidelines
