Anesthetic implications and role of preoperative beta blockade in esophageal substitution with stomach in pediatric surgical patients | ||
| Ain-Shams Journal of Anesthesiology | ||
| Volume 13, Issue 1, January 2021 PDF (582.83 K) | ||
| DOI: 10.1186/s42077-021-00179-x | ||
| Authors | ||
| Raksha Kundal; Ranju Singh* ; Subhasis Roy Choudhury; Partap Singh Yadav; Ajai Kumar; Shalu Gupta; Vijay Kumar Kundal | ||
| Abstract | ||
| Background There is a paucity of literature on the anesthetic management of pediatric esophageal substitution using the stomach. We did a retrospective analysis of all such cases done at our institution. We analyzed the patient’s demography, indication, and type of surgery, co-morbid conditions, anesthesia techniques, duration of postoperative ventilation, hospital stay, complications, and mortality. The use of beta-blockers and their effect on the incidence of intraoperative and postoperative tachycardia in gastric pull-up patients was also analyzed. Results Thirty-four cases of gastric substitution of the esophagus in children were done over 19-year period; gastric pull-up was done in 28 patients and a gastric tube was made in 6 patients. General anesthesia was given to all; a thoracic epidural for pain was sited in 25 patients. Twenty-eight patients were ventilated postoperatively; the mean duration of ventilation is 54 h. Significant intraoperative tachycardia was observed in 85.7% of patients without beta-blocker as compared to 23.8% patients with beta-blocker ( = 0.004). Postoperatively, tachycardia was absent in patients receiving beta-blocker and present in 71.4% of patients not receiving beta-blockers ( < 0.001). Overall mortality was 8.8% but mortality due to cardiac arrhythmia was 42.9% in the patients not receiving beta-blockers ( = 0.001). Conclusions A thorough preoperative preparation, control of tachyarrhythmias, postoperative ventilation, and pain management is recommended for a favorable outcome. In addition, our paper supports the preoperative use of beta-blockers in reducing the incidence of fatal tachyarrhythmias associated with gastric pull-up surgery without any serious adverse effects. Level of evidence Level III | ||
| Keywords | ||
| Pediatric; Tracheoesophageal Fistula; tachycardia; Cardiac Arrhythmias; Metoprolol | ||
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