Perioperative anesthetic and analgesic management of newborn bladder exstrophy repair

Kost-Byerly, Sabine; Jackson, Eric V.; Yaster, Myron; Kozlowski, Lori J.; Mathews, Ranjiv I.; Gearhart, John P.

doi:10.1016/j.jpurol.2008.01.207

« Previous Next »Journal of Pediatric Urology
Volume 4, Issue 4 , Pages 280-285, August 2008

Perioperative anesthetic and analgesic management of newborn bladder exstrophy repair

Sabine Kost-Byerly
- Division of Pediatric Anesthesia, Critical Care Medicine, and Pain Management, Department of Anesthesiology and Critical Care Medicine, Baltimore, MD, USA
- Department of Pediatrics, the Johns Hopkins Hospital and the Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Corresponding author. Johns Hopkins Hospital, 600 N Wolfe St, Blalock 906, Baltimore, MD 21287, USA.
Eric V. Jackson
- Division of Pediatric Anesthesia, Critical Care Medicine, and Pain Management, Department of Anesthesiology and Critical Care Medicine, Baltimore, MD, USA
Myron Yaster
- Division of Pediatric Anesthesia, Critical Care Medicine, and Pain Management, Department of Anesthesiology and Critical Care Medicine, Baltimore, MD, USA
- Department of Pediatrics, the Johns Hopkins Hospital and the Johns Hopkins University, School of Medicine, Baltimore, MD, USA
Lori J. Kozlowski
- Division of Pediatric Anesthesia, Critical Care Medicine, and Pain Management, Department of Anesthesiology and Critical Care Medicine, Baltimore, MD, USA
Ranjiv I. Mathews
- Division of Pediatric Urology, Department of Urology, James Buchanan Brady Urological Institute, Baltimore, MD, USA
- Department of Pediatrics, the Johns Hopkins Hospital and the Johns Hopkins University, School of Medicine, Baltimore, MD, USA
John P. Gearhart
- Division of Pediatric Urology, Department of Urology, James Buchanan Brady Urological Institute, Baltimore, MD, USA
- Department of Pediatrics, the Johns Hopkins Hospital and the Johns Hopkins University, School of Medicine, Baltimore, MD, USA

Received 18 October 2007; accepted 9 January 2008. published online 01 April 2008.

Abstract

Objective

Reconstruction of bladder exstrophy in newborn infants requires immobilization, sedation and pain management to prevent distracting forces from compromising the repair. We present a 6-year review of our experience.

Subjects and methods

We reviewed the perioperative management of newborn infants undergoing reconstruction between November 1999 and October 2006. Data are presented as means±SD.

Results

Twenty-three newborn infants underwent surgery under a combined epidural and general anesthetic technique. Tunneled caudal epidural catheters were inserted in all patients and intermittently injected with 0.25% bupivacaine with 1:200,000 epinephrine. Postoperatively, a continuous infusion of 0.1% lidocaine, 0.8–1mg/kg/h was administered for 15±8 (range 4–30) days. Children were sedated with diazepam for 20±13 (range 2–40) days. Central venous catheters were maintained for 20±9 (range 1–34) days for fluids, drug administration and blood sampling. No patient experienced bladder prolapse or wound dehiscence.

Conclusion

Perioperative management with tunneled epidural and central venous catheters in newborn infants with bladder exstrophy facilitates immobilization, analgesia and sedation, resulting in an excellent cosmetic repair with no case of bladder prolapse or wound dehiscence.

Keywords: Bladder exstrophy, Infant, newborn, Anesthesia, caudal, Analgesia, epidural