Anaesthetic management of gastroschisis - a review of our practice over the past 5 years.
BACKGROUND
Surgical closure of gastrochisis has traditionally been performed under general anesthesia followed by admission to intensive care and postoperative ventilation. We reviewed the management of these neonates in our hospital over the past 5 years to identify the changes in practice and possible factors which affect the peri-operative course.


METHODS
We retrospectively identified cases of gastrochisis undergoing repair from June 2002 to May 2007. Details of the demographic data, preoperative factors, intra-operative anesthetic and surgical management, and postoperative care were collected from the anesthetic chart, operative record, and patient notes.


RESULTS
Forty-eight self-ventilating neonates underwent operative repair in theatre. A neuraxial local anesthetic block was performed as part of the anesthetic technique in 22 patients. There was a significant difference in the need for postoperative ventilation in this group (23%) when compared with a traditional opioid-based method of providing analgesia (88%, P < 0.05). This difference was seen in both term and preterm babies.


CONCLUSIONS
Conclusions are difficult to make when analyzing retrospective data in patients with a heterogeneous variety of factors. The results suggest that anesthesia which includes a regional technique is a valid method in these cases. Traditional opioid analgesia when compared with regional techniques may be associated with increased need for postoperative ventilation.
Raghavan
Murali
M
Department of Anaesthesia, Birmingham Children's Hospital, Birmingham, UK. murali.raghavan@nhs.net
Montgomerie
James
J
D000765:Anesthesia, Conduction / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D005260:Female; D020139:Gastroschisis / Q000150:complications / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome