Neonates undergoing pyloric stenosis repair are at increased risk of difficult airway management: secondary analysis of the NEonate and Children audiT of Anaesthesia pRactice IN Europe

Nicola Disma*, Thomas Engelhardt, NECTARINE Group of the European Society of Anaesthesiology and Intensive, Tom G. Hansen, Jurgen C. de Graaff, Katalin Virag, Walid Habre

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Hypertrophic pyloric stenosis in otherwise healthy neonates frequently requires urgent surgical procedure but anaesthesia care may result in respiratory complications, such as hypoxaemia, pulmonary aspiration of gastric contents, and postoperative apnoea. The primary aim was to study whether or not the incidence of difficult airway management and of hypoxaemia in neonates undergoing pyloric stenosis repair was higher than that in neonates undergoing other surgeries. Methods: Data on neonates and infants undergoing anaesthesia and surgery for pyloric stenosis were extracted from the NEonate and Children audiT of Anesthesia pRactice In Europe (NECTARINE) database, for secondary analysis. Results: We identified 310 infants who had anaesthesia for surgery for pyloric stenosis. Difficult airway management (more than two attempts at laryngoscopy) was higher in children with pyloric stenosis when compared with the entire NECTARINE cohort (7.9% [95% confidence interval {CI}, 5.22–11.53] vs 4.4% [95% CI, 1.99–6.58]; relative risk [RR]=1.81 [95% CI, 1.21–2.69]; P=0.004), whereas transient hypoxaemia with oxygen saturation <90% was comparable between the two cohorts. Postoperative complications occurred in 16 children (5.6%) within the 30-day follow-up. No mortality was reported at 30 and 90 days. Conclusions: Children undergoing surgery for pyloric stenosis had a higher incidence of difficult intubation compared with the entire NECTARINE cohort. Clinical trial registration: NCT 02350348.

Original languageEnglish
Pages (from-to)734-739
Number of pages6
JournalBritish Journal of Anaesthesia
Volume129
Issue number5
DOIs
Publication statusPublished - 1 Nov 2022

Bibliographical note

Funding
European Society of Anaesthesiology and Intensive Care - Clinical Trial Network (ESAIC-CTN).

Publisher Copyright: © 2022 British Journal of Anaesthesia

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