Clinical letter: epidural analgesia in a newborn with Hirschsprung's disease, associated with congenital central hypoventilation syndrome.
A case is presented of a neonate with Hirschsprung's disease, associated with congenital central hypoventilation syndrome. After an ileostomy (at 2 days) and a stoma revision (at 10 days), postoperative pain management was established by continuous intravenous infusion of morphine, which caused severe postoperative respiratory depression. At 6 weeks a re-exploration and stoma revision was performed using postoperative epidural analgesia with bupivacaine. This caused no respiratory depression. A colectomy under epidural analgesia at 8 months was also uneventful. Respiratory difficulties in children with congenital central hypoventilation syndrome associated with Hirschsprung's disease are discussed in relation to the technique of choice for postoperative pain management.
Brouwers
M J
MJ
Department of Anesthesiology and Department of Pediatric Surgery, University Medical Centre St Radboud, Nijmegen, PO Box 9101, 6500 HB, The Netherlands.
Driessen
J J
JJ
Severijnen
R S
RS
D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D003864:Depression, Chemical; D006627:Hirschsprung Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D010149:Postoperative Pain / Q000628:therapy*; D012119:Respiration / Q000187:drug effects; D020182:Sleep Apnea, Central / Q000150:complications* / Q000151:congenital
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine