作者: shenxiu2 时间: 2009-11-9 16:38 1#songhailong Pyloric stenosis:
Presentation:
1 in 300 live births.
First born males usually .80% males. 10% premature.
Between 2 to 6 weeks of age.
Persistent vomiting , dehydration,hypochloremia, and alkalosis.
Continued vomiting & dehydration can lead to metabolic acidosis.
Olive like mass felt in the epigastrium.
Confirm diagnosis by ultrasound abdomen.
Perioperative management :
1. Electrolyte & volume imbalances need to be corrected before taking to Operation room , surgery is not an emergency .
Chloride should be corrected to more than 90 mmol/litre.HCO3- & pH should be within normal range .
Resuscitation fluids : use 0.45% NaCl in 5% Dextrose+20 mmol/litre KCl. Replace the nasogastric loss with 0.9% NaCl+ 20 mmol/Litre KCl. Use colloid if hypovolemia is present.
Another option : If HCO3- is less than 32mmol/litre, use 0.45% NaCl , if HCO3- is more than 32mmol/litre, use 0.9% NaCl to resuscitate.
2. Must insert a nasogastric tube with continuous suction.
3. At risk for aspiration;need rapid sequence induction with cricoid pressure , some people do awake intubation.
4.Choice of anesthetic agent & muscle relaxants are depending on the speed of the surgeon. ( surgery can take 10 to 60 minutes)
5.Opiods not necessary , should be avoided. Can give local anesthetic infiltration to the wound.( 0.25% bupivacaine 1ml/kg )
Post operative period should monitor for apnea for 24 hours, especially if the patient is a premature neonate.作者: shenxiu2 时间: 2009-11-9 19:14
先天性幽门狭窄麻醉
大约每三百名婴儿有一宗。多数是头生男孩。8 0%男婴。10%未足月。多数是二星期至六星期大之间。
持续呕吐，脱水，低Cl-，碱中毒。
长久持续呕吐，脱水可能会造成代谢性酸中毒。
诊断：上腹有一橄榄状硬块。由腹部超声确定。