Perioperative apnea in infants with hypertrophic pyloric stenosis: A systematic review

Abstract

Background Infantile hypertrophic pyloric stenosis (IHPS) leads to excessive vomiting and metabolic alkalosis, which may subsequently cause apnea. Although it is generally assumed that metabolic derangements should be corrected prior to surgery to prevent apnea, the exact incidence of perioperative apneas in infants with IHPS and the association with metabolic alkalosis are unknown. We performed this systematic review to assess the incidence of apnea in infants with IHPS and to verify the possible association between apnea and metabolic alkalosis. Methods We searched MEDLINE, Embase, and Cochrane library to identify studies regarding infants with metabolic alkalosis, respiratory problems, and hypertrophic pyloric stenosis. We conducted a descriptive synthesis of the findings of the included studies. Results Thirteen studies were included for analysis. Six studies described preoperative apnea, three studies described postoperative apnea, and four studies described both. All studies were of low quality or had other research questions. We found an incidence of 27% of preoperative and 0.2%‐16% of postoperative apnea, respectively. None of the studies examined the association between apnea and metabolic alkalosis in infants with IHPS. Conclusions Infants with IHPS may have a risk to develop perioperative apnea. However, the incidence rates should be interpreted with caution because of the low quality and quantity of the studies. Therefore, further studies are required to determine the incidence of perioperative apnea in infants with IHPS. The precise underlying mechanism of apnea in these infants is still unknown, and the role of metabolic alkalosis should be further evaluated.

Perioperative Hypoxemia and Postoperative Respiratory Events in Infants with Hypertrophic Pyloric Stenosis

“…In this study, we found an incidence of postoperative apnea of 3.0%, which is in line with the results of 0.2 to 16% in a recent systematic review. 7 The total incidence of postoperative respiratory events, consisting of desaturation, stridor, hypopnea, and apnea was 21.2%. We found that infants who underwent open pyloromyotomy had more often a period of perioperative hypoxemia and less often postoperative respiratory events compared to infants who underwent a laparoscopic procedure.…”

“…6 In a recent literature review, we showed an incidence of postoperative respiratory events in infants with IHPS of 0.2 to 16%. 7 However, this review was hampered by a small number of included patients and the lack of studies that primarily investigated the occurrence of apnea in infants with IHPS. In addition, the included studies used different definitions of apnea that led to heterogeneous results regarding the occurrence of postoperative respiratory events.…”

Pyloric Stenosis and Nonbilious Vomiting in Infants: Negative Base Excess and Hypercapnia—Two Opposing Points of One Scale a Comparative Case Series

“…There are at least two case reports regarding preoperatively apneic infants with pyloric stenosis [4] [12]. However, the detailed trigger and incidence of pre-or postoperative apnea in pyloric stenosis are not well known [13].…”

Fluid therapy in pyloric stenosis – assessment of the implementation of hospital guidelines

“…Intravenous fluid therapy in pyloric stenosis must correct metabolic alkalosis, which increases the risk of apneas in the postoperative period. 3,[7][8][9] It should provide the right amount of sodium so as not to lead to postoperative hyponatremia with all its consequences (including vomiting). Because of the high risk of hypoglycemia in infants, it should also provide enough glucose.…”