title: Management of hypertrophic pylorus stenosis with ultrasound guided single shot epidural anaesthesia--a retrospective analysis of 20 cases.
abstract: OBJECTIVE
  To retrospectively describe the performance of ultrasound guided thoracic epidural anaesthesia under sedation for anaesthesia management of open pyloromyotomy.
  
  
  BACKGROUND
  Anaesthesia management for hypertrophic pylorus stenosis (HPS) is usually performed under general anaesthesia with tracheal intubation. Only a few publications describe avoidance of tracheal intubation in infants by using spinal or caudal anaesthesia. The present retrospective analysis describes the performance of ultrasound guided thoracic epidural anaesthesia under sedation for anaesthetic management of open pyloromyotomy.
  
  
  METHODS
  Twenty consecutive infants scheduled for pyloromyotomy according to the Weber-Ramstedt technique were retrospectively analysed. After sedation with nalbuphine and propofol, an ultrasound guided single shot thoracic epidural anaesthesia was performed with 0.75 ml·kg(-1) ropivacaine 0.475%. Insufficient blockade was defined as increase of HR > 15% from initial value and/or any movements at skin incision. In those cases we were prepared for rapid sequence intubation according to the departmental standard.
  
  
  RESULTS
  All pyloromyotomies could be performed under single shot thoracic epidural anaesthesia and sedation. One case of moderate oxygen desaturation was treated with intermittent ventilation via face mask.
  
  
  CONCLUSIONS
  Thoracic epidural anaesthesia under sedation for pyloromyotomy has been a useful technique in this retrospective series of infants suffering from HPS. In 1/20 infants short term assisted ventilation via face mask was required. Undisturbed surgery was possible in all cases.
authors.affiliation: Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Harald
authors.initials: H
authors.lastname: Willschke
authors.forename: Anette-Marie
authors.initials: AM
authors.lastname: Machata
authors.forename: Winfried
authors.initials: W
authors.lastname: Rebhandl
authors.forename: Thomas
authors.initials: T
authors.lastname: Benkoe
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Kettner
authors.forename: Lydia
authors.initials: L
authors.lastname: Brenner
authors.forename: Peter
authors.initials: P
authors.lastname: Marhofer
mesh_terms: D000767:Anesthesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000493:pharmacokinetics; D001784:Blood Gas Analysis; D016292:Procedural Sedation; D004632:Emergency Medical Services; D004824:Epidural Space / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative; D010147:Pain Measurement; D046248:Pyloric Stenosis, Hypertrophic / Q000000981:diagnostic imaging* / Q000601:surgery*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013129:Spinal Puncture; D014463:Ultrasonography
chemical_list: D000779:Anesthetics, Local