title: [Ultrasound-guided paravertebral block for pyloromyotomy in 3 neonates with congenital hypertrophic pyloric stenosis].
abstract: OBJECTIVE
  Hypertrophic pyloric stenosis is a relatively common affection of gastrointestinal tract in childhood that results in symptoms, such as projectile vomiting and metabolic disorders that imply a high risk of aspiration during anesthetic induction. In this way, the carrying out of a technique with general anesthesia and intravenous rapid sequence induction, preoxygenation and cricoid pressure are recommended. After the correction of systemic metabolic alkalosis and pH normalization, cerebrospinal fluid can keep a state of metabolic alkalosis. This circumstance, in addition to the residual effect of neuromuscular blocking agents, inhalant anesthetics and opioids could increase the risk of postoperative apnea after a general anesthesia.
  
  
  METHODS
  We present the successful management in 3 neonates in those a pyloromyotomy was carried out because they had presented congenital hypertrophic pyloric stenosis. This procedure was done under general anesthesia with orotracheal intubation and rapid sequence induction. Then, ultrasound-guided paravertebral block was performed as analgesic method without the need for administrating opioids within intraoperative period and keeping an appropriate analgesic level.
  
  
  CONCLUSIONS
  Local anesthesia has demonstrated to be safe and effective in pediatric practice. We consider the ultrasound-guided paravertebral block with one dose as a possible alternative for other local techniques described, avoiding the use of opioids and neuromuscular blocking agents during general anesthesia, and reducing the risk of central apnea within postoperative period.
authors.affiliation: Departamento de Anestesiologia e Reanimação, Hospital Universitário Virgen del Rocío, Sevilha, Espanha.
authors.forename: Javier
authors.initials: J
authors.lastname: Mata-Gómez
authors.affiliation: Departamento de Anestesiologia e Reanimação, Hospital Universitário Virgen del Rocío, Sevilha, Espanha. Electronic address: rosanabixi7@hotmail.com.
authors.forename: Rosana
authors.initials: R
authors.lastname: Guerrero-Domínguez
authors.affiliation: Departamento de Anestesiologia e Reanimação, Hospital Universitário Virgen del Rocío, Sevilha, Espanha.
authors.forename: Marta
authors.initials: M
authors.lastname: García-Santigosa
authors.affiliation: Departamento de Anestesiologia e Reanimação, Hospital Universitário Virgen del Rocío, Sevilha, Espanha.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ontanilla
keywords: Anestesia regional; Bloqueio paravertebral; Estenose hipertrófica de piloro; Hypertrophic pyloric stenosis; Paravertebral block; Pediatrics; Pediátrica; Piloromiotomia; Pyloromyotomy; Regional anesthesia