Postanesthetic Apnea in Full-term Infants after Pyloromyotomy

Andropoulos, Dean B.; Heard, Maurine B.; Johnson, Kate; Clarke, Jonathan T.; Rowe, Richard W.

doi:10.1097/00000542-199401000-00031

Cited by 51 publications

(55 citation statements)

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“…In our study six (75%) babies were started on oral feeds within 12 hrs, one after 48 hrs, owing to vomiting in post operative period and in one case, feeding was withheld till 72 hrs after surgery due to a mucosal perforation. In the postanaesthesia recovery period, the infant should be carefully observed for signs of respiratory depression and periods of apnoea secondary to effects of metabolic alkalosis, general anaesthesia, and decreased body temperature [10]. Anaesthesia related morbidity rate, once noted to be as high as 3.7%, is on the decline and recent studies have shown no complications after general anaesthesia [11,12].…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Hypertrophie Pyloric Stenosis : Our Experience

Puri

Sreevastava

Kalra³

2006

Medical Journal Armed Forces India

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Background : A typical infant with idiopathic hypertrophic pyloric stenosis is described as a male child, first in the order of birth with a positive family history. However our experience suggests otherwise which is presented in this report. Methods : A retrospective analysis of medical records of 8 infants, who were diagnosed to be suffering from idiopathic hypertrophic pyloric stenosis and subjected to surgical treatment, was undertaken. Results : There were 5 (62.5%) males and 3 (37.5%) females. There was no family history and only one child (12.5%) was first born in the order of birth. One infant was preterm and one case (12.5%) had associated congenital anomaly (single kidney). Definitive diagnosis was established in 6 (75%) babies at admission whereas, other 2 cases (25%) required further evaluation. All the infants were in a state of moderate dehydration and in a varying state of hypochloremic alkalosis. The pH and serum chloride levels ranged from 7.52 to 7.67 and 86-94 mmol/L respectively. All were subjected to traditional Ramstedt's pyloromyotomy after having undergone vigorous correction of fluids and electrolytes for 24-48 hours. Intraoperatively, there was one iatrogenic mucosal perforation, which was closed with an omental patch. Postoperative feeding was initiated 12 hrs after surgery in 6 (75%) babies. Conclusion : Our series suggests a clinical profile of hypertrophic pyloric stenosis in our subset of patients which is different from what is described in literature. MJAFI 2006; 62 : 216-219

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Section: Discussionmentioning

confidence: 99%

Idiopathic Hypertrophie Pyloric Stenosis : Our Experience

Puri

Sreevastava

Kalra³

2006

Medical Journal Armed Forces India

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“…3 Apneic events occur in both the early and late postoperative course. 1,3,4,8,9 At present, no physiologic index of breathing has been reported to predict the risk for apnea in infants following anesthesia, although two clinical reports suggest that the periodic breathing and multiple brief apneas in infants are breathing patterns at risk for PoA. 9,10 Respiratory inductive plethysmography (RIP) has been used extensively to assess infants and children with sleep disordered breathing.…”

Section: Résultatsmentioning

confidence: 99%

“…1,3,4,8,9 At present, no physiologic index of breathing has been reported to predict the risk for apnea in infants following anesthesia, although two clinical reports suggest that the periodic breathing and multiple brief apneas in infants are breathing patterns at risk for PoA. 9,10 Respiratory inductive plethysmography (RIP) has been used extensively to assess infants and children with sleep disordered breathing. [11][12][13] This research method has not been applied to the study of PoA, which has primarily been studied with transthoracic impedance, nasal thermistry, and pneumograms.…”

Section: Résultatsmentioning

confidence: 99%

“…[11][12][13] This research method has not been applied to the study of PoA, which has primarily been studied with transthoracic impedance, nasal thermistry, and pneumograms. [2][3][4]8,9 We hypothesized that RIP was well suited to evaluate the breathing pattern in infants recovering from anesthesia. Since the data analysis would be greatly facilitated by a method that automatically detects respiratory pauses, we have developed algorithms which measure the energy contained in the ribcage and abdomen signals of RIP and apply thresholds to detect both movement and pauses.…”

Section: Résultatsmentioning

confidence: 99%

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Automated respiratory inductive plethysmography to evaluate breathing in infants at risk for postoperative apnea

Brown

Aoude

Galiana

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Although respiratory inductive plethysmography (RIP) is the method of choice for the assessment of sleep disordered breathing, it has not been applied to the study of infants at risk for postoperative apnea (POA). The purpose of this study was to apply RIP to evaluate breathing in these infants. An additional purpose was to implement, simultaneously, three novel algorithms to detect movement artifact, respiratory pauses, and thoracoabdominal asynchrony, since their combined output both detects respiratory pauses and classifies them as obstructive or central in origin. Methods:A prospective study design was employed to record the analogue output of RIP, saturation, and finger plethysmography in a convenience sample of infants. The data record underwent a dual analysis: 1) automated detection of respiratory events; and 2) visual coding of the cardiorespiratory data. A novel index, coined pause density, was calculated as the sum of all respiratory pauses.Results: Twenty infants, whose mean postconceptional ages and weights were 44.47 ± 2.88 weeks and 4.21 ± 0.99 kg, respectively, were recruited. Data recording ranged from four to 24 hr. Ten infants (term = 5) experienced POA: central apnea = 5, mixed obstructive apnea = 6, and two former premature infants experienced both. Twenty-five central apneic events were detected, and the majority followed a sigh. Infants who experienced apnea also had high values of pause density. Conclusion:Respiratory inductive plethysmography may provide a useful method to evaluate breathing in infants at risk for POA. The study of short respiratory pauses may prove useful in predicting apnea risk.

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“…In contradiction with Chipps, Andropoulos reports on postanesthetic apnea in four full-term infants after pyloromyotomy. 17 None of the infants had received narcotics. One of the hypothesis brought forth to explain the occurrence of apnea postoperatively, is that cerebrospinal pH may still be elevated despite normalization of blood pH.…”

mentioning

confidence: 99%

The Pierre Limoges Pediatric Anesthesia Lecture: Tricky problems in pediatric anesthesia

Lavoie

2004

Can J Anesth/J Can Anesth

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Postanesthetic Apnea in Full-term Infants after Pyloromyotomy

Cited by 51 publications

References 0 publications

Idiopathic Hypertrophie Pyloric Stenosis : Our Experience

Idiopathic Hypertrophie Pyloric Stenosis : Our Experience

Automated respiratory inductive plethysmography to evaluate breathing in infants at risk for postoperative apnea

The Pierre Limoges Pediatric Anesthesia Lecture: Tricky problems in pediatric anesthesia

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