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Delayed extubation and hypertrophic pyloric stenosis: what are the predictive factors?
Sabrine Ben Youssef1, Syrine Laribi1, Sawsen Chakroun2
1Department of Pediatric Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia.
Insights
Delayed extubation in infants undergoing surgery for hypertrophic pyloric stenosis (HPS) is common. Metabolic alkalosis is a key predictor of prolonged recovery after general anesthesia for HPS surgery.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Neonatal Care
Background:
- Prolonged extubation after general anesthesia, defined as >15 min from surgery end to tracheal extubation, impacts operating room efficiency.
- This issue is frequent in infants with hypertrophic pyloric stenosis (HPS), potentially delaying care for other patients.
Purpose of the Study:
- To determine the frequency of delayed extubations in infants undergoing extramucosal pyloromyotomy under general anesthesia.
- To identify predictive factors associated with delayed extubation in this patient population.
Main Methods:
- Retrospective and comparative study conducted between January 2020 and December 2023.
- Analysis of 34 infant cases of HPS treated surgically.
- Statistical comparison of factors including age, operative time, and preoperative conditions.
Main Results:
- Delayed extubation occurred in 19 out of 34 infants; 3 experienced very prolonged extubation (>60 min).
- Metabolic alkalosis was identified as a significant predictive factor for delayed extubation (p < 0.05).
- No significant association was found between delayed extubation and prematurity, hypotrophy, dehydration, or electrolyte imbalances.
Conclusions:
- Metabolic alkalosis is a predictive factor for delayed extubation in infants undergoing general anesthesia for HPS.
- Spinal anesthesia is suggested as a potential alternative, though comparative data remain limited and its use is debated.
Introduction:
Prolonged time to extubation after general anesthesia has been defined as a delay of more than 15 min from the end of surgery to tracheal extubation. This incident is frequently seen in infants operated on for hypertrophic pyloric stenosis (HPS), which can lead to inefficient use of operating rooms and delayed care for other patients.
Aim:
To evaluate the frequency of "delayed extubations" in infants who have received an extramucosal pyloromyotomy under general anesthesia and to identify the predictive factors of this incident.
Methods:
We report a retrospective and comparative study of patients operated for HPS at the pediatric surgery department of Monastir, between January 2020 and December 2023.
Results:
Thirty-four cases were collected. Delayed extubation occurred in 19 cases with very prolonged extubation (>60 min) in 3 cases. The mean age at diagnosis was 38.07 days for group 1 and 34.42 days for group 2. The average of operating time was 56 min for both groups. On the χ 2 test, the difference between the groups was significant for metabolic alkalosis. However, the results were not significant for the other criteria (prematurity, hypotrophy, dehydration, hyponatremia, hypochloremia, hypokalemia, functional renal failure, pre-operative resuscitation time).
Conclusions:
These data suggest that metabolic alkalosis is predictive of delayed extubation in infants operated on for HPS under general anesthesia. The use of spinal anesthesia may be an alternative to general anesthesia but it remains a controversial issue, as there are few comparative data.
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