Anaesthetic management of bladder exostrophy in a three month old baby

Abstract

Exostrophy of bladder and cloaca are the defects in the ventral abdominal wall caused due to failure of mesodermal invasion of cloacal membrane at 4-5 weeks of gestation. These congenital defects require multistaged repair and surgeries can last longer therefore causing repeated exposure of the baby to anaesthesia and can cause electrolyte imbalance, infection, hypothermia, coagulopathies and even mortality. We report a case of exostrophy of bladder with epispadius in a three month old child which was done under general anaesthesia and continous caudal catheter infusion of bupivaciane in intraoperative and postoperative period which helped in providing opioid free analgesia thus avoiding their respiratory depressant effects and aided in the early recovery of the baby.