Anestesia e Pesquisa Clínica
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Induction and Airway Management for Pyloromyotomy

Alison A. Considine, Inna Maranets, Denis Snegovskikh, Shu-Ming Wang

Study background: Infants with pyloric stenosis are considered having a full stomach; however, rapid sequence induction has not been the only method used to secure the airway. A retrospective chart review was performed to evaluate the differences in incidences of adverse outcomes (e.g., desaturation, aspiration, and failed the first attempt intubation) between various induction and airway management techniques.

Methods: A retrospective chart review over a 10-year period was conducted at a University affiliated children’s hospital. Induction and airway management techniques were abstracted from medical charts, and the incidences of aspiration, desaturation, failed the first attempt intubation, and duration of hospitalization were also recorded.

Results: One hundred patients received intravenous rapid sequence induction with succinylcholine (42.6%), 78 patients received IV induction with non-depolarizing muscle relaxant (33.1%), 18 patients received IV propofol only (7.7%), 35 received inhalation induction (14.9%), and 4 received awake intubation (1.7%). There was no incidence of aspiration (0%) for all inductions, while 27 (11.4%) infants that received intravenous induction experienced desaturation during induction. We found that patients that received awake intubation had longer postoperative stays as compared to patients that received rapid sequence induction (p=0.017) and inhalation induction (p=0.016).

Conclusions: This retrospective chart review concluded that there were no differences in the incidence of aspiration, desaturation, and the rate of successful first attempt intubation between various types of induction techniques. Rapid sequence induction with succhinylcholine was the most popular induction technique to secure the airway of infants with pyloric stenosis undergoing pyloromyotomy.