Repair of incarcerated inguinal hernia in an infant with acute viral bronchiolitis

Abstract

P Pu ur rp po os se e: : To describe the anesthetic concerns and management options in an infant with acute viral bronchiolitis who required emergency surgery.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 12-week-old infant presented to the emergency department with an incarcerated right inguinal hernia. The history was complicated by concurrent acute bronchiolitis. As the hernia was irreducible, emergency surgery was required. General endotracheal anesthesia, following a rapid sequence induction, was supplemented with a caudal epidural block. Inhaled salbutamol and suctioning for thick tracheal secretions were required and were found to be clinically useful. The baby made a good postoperative recovery.C Co on nc cl lu us si io on ns s: : A variety of techniques may be used to anesthetize the infant with concurrent acute bronchiolitis. In this case a good outcome was achieved with combined general and regional anesthesia, together with the use of inhaled salbutamol. CUTE viral bronchiolitis is a common respiratory infection in infants. The causal agent is nearly always the respiratory syncytial virus (RSV). It is estimated that approximately 1% of infants with RSV infection will require hospitalization and that these account for more than 125,000 admissions per annum in the United States. 1 The clinical features of RSV bronchiolitis are those of an acute viral illness, characterized by wheezing and respiratory distress. The recovery period may be quite prolonged and residual airway reactivity may persist for months or even years after an infection. 2 In infants in the acute phase of RSV bronchiolitis who require elective surgery, the operation is generally postponed until the infection has resolved. The exact period required before anesthesia can be undertaken is unclear and will depend on many factors, including the urgency of the surgery. Occasionally an infant with active bronchiolitis will present for emergency surgery and some form of anesthesia will be required. ObjectifA case is presented of a 12-week-old baby with moderately severe bronchiolitis, who presented with an incarcerated inguinal hernia. Options for anesthesia are presented and the topic of RSV infection and anesthesia is discussed.C Ca as se e r re ep po or rt t The infant was a 5.1-kg male, born at 37 weeks postconceptual age. There were no neonatal concerns and he was quite well until the age of 12 weeks. At this time, five days prior to admission, he developed a fever, runny nose and congested cough. He was medicated with acetaminophen at home. On the day of presentation the

Anesthetic management of a pediatric patient with severe Williams-Campbell syndrome undergoing surgery for giant ovarian tumor

“…Moreover, our patient became infected with RSV only 1 week prior to the planned date of surgery. As residual airway reactivity may persist for months or even years after RSV infection [11], it is unclear how long surgery should be postponed [12]. As our patient had extremely labored breathing due to abdominal distension, we scheduled the surgery immediately after the infectious symptoms subsided.…”

Anesthesia in children with a cold

“…Infants suffering from RSV infection are at a specifically increased risk when they have to be anesthetized [18,19].…”

Infektionen mit dem „respiratory syncytial virus“

“…Die Korrektur kongenitaler Herzfehler innerhalb von 2 Wochen nach einer RSV-Infektion, d. h. noch in derselben Hospitalisation, geht mit mehr Komplikationen und auch einer erhöhten Letalitätsrate einher [15]. Cox [16] berichtet über intraoperative Entsättigungen wäh-rend der Operation einer inkarzerierten Hernie bei einem Kind mit Bronchiolitis. Postoperativ gilt es zu beachten, dass RSV-Infektionen auch ohne Anästhesie zu Apnoen und Bradykardie führen kön-nen [17,18].…”