Eur J Pediatr Surg 2020; 30(05): 440-446
DOI: 10.1055/s-0039-1692656
Original Article

Neuromuscular Blocking Agents and Rapid Sequence Induction for Laparoscopic Pyloromyotomy: Impact on Time to Extubation and Perioperative Complications

Dominique Swenker
1  Department of Anesthesiology, Erasmus Medical Centre-Sophia Children’s Hospital, Rotterdam, The Netherlands
,
Anna van der Knijff-van Dortmont
1  Department of Anesthesiology, Erasmus Medical Centre-Sophia Children’s Hospital, Rotterdam, The Netherlands
,
Antonia Gonzalez Candel
1  Department of Anesthesiology, Erasmus Medical Centre-Sophia Children’s Hospital, Rotterdam, The Netherlands
,
Claudia Keyzer-Dekker
2  Department of Pediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
,
Lonneke Staals
1  Department of Anesthesiology, Erasmus Medical Centre-Sophia Children’s Hospital, Rotterdam, The Netherlands
› Author Affiliations
Funding None.

Abstract

Introduction Infants with hypertrophic pyloric stenosis have gastric outlet obstruction, indicating a pyloromyotomy. To prevent aspiration, a rapid sequence induction (RSI) of anesthesia used to be preferred. However, due to concerns about the side-effects of this technique in infants, a modified RSI with gentle mask ventilation is nowadays mostly used. This research investigates if induction with succinylcholine (classic RSI), cisatracurium (modified RSI), or no neuromuscular blocking agent (NMBA) influences time until extubation and incidence of complications in infants undergoing laparoscopic pyloromyotomy.

Materials and Methods A retrospective chart review was performed, observing infants undergoing laparoscopic pyloromyotomy in Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, from January 2007 until July 2015. Baseline preoperative data, anesthesia and operation details, time to extubation, and reported complications were gathered. Inclusion criteria were maintenance of anesthesia with sevoflurane and a registered extubation time. Exclusion criteria were the use of combinations of NMBAs, repyloromyotomy, and conversion to laparotomy.

Results A total of 168 patients were included, of which 21 received succinylcholine, 107 cisatracurium, and 40 no NMBA. Mean duration of surgery was 29 minutes in all three groups; mean duration of anesthesia was 89, 82, and 77 minutes; mean time to extubation was 26, 25, and 23 minutes, respectively, without statistically significant difference. Complications were evenly distributed, no aspiration occurred.

Conclusion The use of succinylcholine, cisatracurium, or no NMBA at induction of anesthesia in infants undergoing laparoscopic pyloromyotomy had no statistically significant effect on time until extubation and complication rates. A modified RSI seems to be safe and effective in these cases.



Publication History

Received: 20 November 2018

Accepted: 14 May 2019

Publication Date:
26 June 2019 (online)

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