Abstract
Gastroschisis is congenital anomaly characterized by a defect in the anterior abdominal wall with evisceration of abdominal contents. Choice of anaesthesia for its repair varies from conventional general anaesthesia with opioids for analgesia, general anaesthesia along with regional techniques like spinal and caudal blocks or sole regional anaesthesia. Aims -To retrospectively analyze various techniques used for anaesthetic management of gastroschisis repair surgery in our institute and compare outcome of patients in terms of extubation time and requirement of postoperative mechanical ventilation. Material and Methods -Eighty-two cases operated for gastroschisis in our hospital over a period of four years were retrospectively analyzed in terms of age, sex, gestation, type of surgical procedure and anaesthesia techniques. Time of extubation and requirement of postoperative mechanical ventilation was compared between general anaesthesia and regional anesthesia group. Results – Seventy-two cases were with 28 patients in general anaesthesia group and 44 patients in regional group. Out of 14 term neonates 2 needed post-operative ventilation in regional group. 6 out of 10 term neonates needed postoperative ventilation in opioid group. Among preterm neonates 12 out of 30 needed post operative ventilation in regional group and all 18 needed postoperative ventilation in opioid group. In both term as well as preterm patients, regional group had faster extubation rate and lesser need of postoperative ventilation when compared to general anaesthesia group. Difference was statistically significant. Conclusion- We conclude that use of regional blocks along with general anaesthesia is safe and effective for management of neonates with gastroschisis presenting for primary repair.
Highlights
Gastroschisis is a congenital anomaly in which there is a defect of abdominal wall and evisceration of abdominal contents which include small and large intestine and occasionally spleen and liver
Among preterm neonates 12 out of 30 needed post-operative ventilation in regional group and all 18 needed postoperative ventilation in opioid group. In both term as well as preterm patients, regional group had faster extubation rate and lesser need of postoperative ventilation when compared to general anaesthesia group
We conclude that use of regional blocks along with general anaesthesia is safe and effective for management of neonates with gastroschisis presenting for primary repair
Summary
Gastroschisis is a congenital anomaly in which there is a defect of abdominal wall and evisceration of abdominal contents which include small and large intestine and occasionally spleen and liver. Defect is usually 2 to 5cm and is more common on Surgical management of gastroschisis includes primary surgical closure of abdominal wall and staged closure, in which silo (silastic or teflon mesh) is used to close the defect.[3]. Another approach is use of spring-loaded silo in NICU or in delivery room where slow reduction of extra abdominal content is done followed by prosthesis removal and closure of defect under anaesthesia.[4] Choice of anaesthesia varies from conventional general anaesthesia with opioids for analgesia, general anaesthesia along with regional techniques like spinal and caudal blocks.
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