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Neuromuscular Blocking Agents and Rapid Sequence Induction for Laparoscopic Pyloromyotomy: Impact on Time to

Dominique Swenker1, Anna van der Knijff-van Dortmont1, Antonia Gonzalez Candel1

  • 1Department of Anesthesiology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
|June 27, 2019
PubMed

Insights

For infants undergoing laparoscopic pyloromyotomy, anesthesia induction with succinylcholine, cisatracurium, or no neuromuscular blocking agent (NMBA) did not significantly impact extubation time or complications. Modified rapid sequence induction (RSI) appears safe and effective.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery

Background:

  • Infants with hypertrophic pyloric stenosis require pyloromyotomy due to gastric outlet obstruction.
  • Historically, rapid sequence induction (RSI) was preferred for aspiration prevention, but modified RSI with gentle mask ventilation is now common due to infant-specific side effects.

Purpose of the Study:

  • To investigate the influence of different neuromuscular blocking agents (NMBAs) on extubation time and complication incidence in infants undergoing laparoscopic pyloromyotomy.
  • To compare classic RSI (succinylcholine), modified RSI (cisatracurium), and no NMBA during anesthesia induction for this procedure.

Main Methods:

  • Retrospective chart review of 168 infants undergoing laparoscopic pyloromyotomy between January 2007 and July 2015.
  • Data collected included preoperative details, anesthesia/operation specifics, extubation time, and complications.
  • Inclusion criteria: sevoflurane anesthesia, registered extubation time; exclusion criteria: combined NMBAs, re-operation, or conversion to laparotomy.

Main Results:

  • No statistically significant difference in mean time to extubation (26, 25, and 23 minutes for succinylcholine, cisatracurium, and no NMBA groups, respectively).
  • Mean surgery duration was consistent across groups (29 minutes).
  • Complication rates were similar across all groups, with no reported aspiration events.

Conclusions:

  • Anesthesia induction using succinylcholine, cisatracurium, or no NMBA does not significantly affect extubation time or complication rates in infants undergoing laparoscopic pyloromyotomy.
  • Modified RSI with gentle mask ventilation is a safe and effective anesthetic approach for this pediatric surgical procedure.
Abstract

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