Keyword
HPS, hypertonic pyloric stenosis
Definition
stomach pylorus의 muscle hypertrophy로 severe projectile non-bilious vomiting을 특징으로 하는 소아질환
수술적 치료로 pyloromyotomy시행, 주로 생후 3-6주
Anesthetic major concern
**절대 응급수술이 아님**
아기 evaluation 잘하고 severe metabolic imbalance 교정하고 수술준비
Induction
Wide-bore catheter suctioning stomach
Supine, right, left lateral position
Induction 직전에 가능한 stomach contents제거 (98%가능)
Awake intubation : low-dose rocironium(0.3mg/kg) 사용
or rapid sequence intubation (cricoid pressure after atropine 0.02mg/kg, propofol 3mg/kg, succinylcholine 2mg/kg)
Post operative care
post operative analgesia
**Halothane anesthesia : new onset apnea (술 후3-13살에서) 술 후 monitoring 필요!
**Lactate metabolized bicarbonate : alkalosis 심해짐 H/S 금기!!
Reference
Miller’s Anesthesia, 8th edition, Chapter 93: Pediatric Anesthesia, p.2793