Hypertrophic pyloric stenosis (HPS) in an important differential diagnosis in the vomiting infant and remains the most common condition that requires surgical treatment in this age group.
Beyond the common issues that are faced by an anesthesia provider when delivering anesthesia to an infant, management of HPS requires an increased awareness of a number of potential pitfalls.
A review of the anatomy and physiology of the disease is presented, and the medical issues surrounding adequate correction of hydration status, and blood chemistry are discussed.
Safe anesthesia involves addressing aspiration risk at the start of the case and balancing reliable analgesia with the risk of apneas in the post-operative phase. The various benefits and drawbacks of the current induction strategies for general anesthesia, and the potential role for regional anesthesia are explored.
Pyloromyotomy has traditionally been done via the open Ramstedt procedure, but recently with the expansion of laparoscopic surgery, it is important to review the implications of pneumoperitoneum in the infant population.
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