Advertisement

Perioperative anesthetic and analgesic management of newborn bladder exstrophy repair

  • Sabine Kost-Byerly
    Correspondence
    Corresponding author. Johns Hopkins Hospital, 600 N Wolfe St, Blalock 906, Baltimore, MD 21287, USA.
    Affiliations
    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
    Search for articles by this author
  • Eric V. Jackson
    Affiliations
    Division of Pediatric Anesthesia, Critical Care Medicine, and Pain Management, Department of Anesthesiology and Critical Care Medicine, Baltimore, MD, USA
    Search for articles by this author
  • Myron Yaster
    Affiliations
    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
    Search for articles by this author
  • Lori J. Kozlowski
    Affiliations
    Division of Pediatric Anesthesia, Critical Care Medicine, and Pain Management, Department of Anesthesiology and Critical Care Medicine, Baltimore, MD, USA
    Search for articles by this author
  • Ranjiv I. Mathews
    Affiliations
    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
    Search for articles by this author
  • John P. Gearhart
    Affiliations
    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
    Search for articles by this author

      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, 0.8–1 mg/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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nelson C.P.
        • Dunn R.L.
        • Wei J.T.
        Contemporary epidemiology of bladder exstrophy in the United States.
        J Urol. 2005; 173: 1728
        • Husmann D.A.
        Surgery insight: advantages and pitfalls of surgical techniques for the correction of bladder exstrophy.
        Nat Clin Pract Urol. 2006; 3: 95
        • Oesterling J.E.
        • Jeffs R.D.
        The importance of a successful initial bladder closure in the surgical management of classical bladder exstrophy: analysis of 144 patients treated at the Johns Hopkins Hospital between 1975 and 1985.
        J Urol. 1987; 137: 258
        • Husmann D.A.
        • McLorie G.A.
        • Churchill B.M.
        Closure of the exstrophic bladder: an evaluation of the factors leading to its success and its importance on urinary continence.
        J Urol. 1989; 142: 522
        • Meldrum K.K.
        • Baird A.D.
        • Gearhart J.P.
        Pelvic and extremity immobilization after bladder exstrophy closure: complications and impact on success.
        Urology. 2003; 62: 1109
        • Anand K.J.
        • Hickey P.R.
        Halothane–morphine compared with high-dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery.
        N Engl J Med. 1992; 326 ([see comments]): 1
        • Bosenberg A.T.
        Epidural analgesia for major neonatal surgery.
        Paediatr Anaesth. 1998; 8: 479
        • Larsson B.A.
        • Lonnqvist P.A.
        • Olsson G.L.
        Plasma concentrations of bupivacaine in neonates after continuous epidural infusion.
        Anesth Analg. 1997; 84: 501
        • Aram L.
        • Krane E.J.
        • Kozloski L.J.
        • et al.
        Tunneled epidural catheters for prolonged analgesia in pediatric patients.
        Anesth Analg. 2001; 92: 1432
        • Fisher Q.A.
        • Shaffner D.H.
        • Yaster M.
        Detection of intravascular injection of regional anaesthetics in children.
        Can J Anaesth. 1997; 44 ([see comments]): 592
        • Gearhart J.P.
        • Forschner D.C.
        • Jeffs R.D.
        • et al.
        A combined vertical and horizontal pelvic osteotomy approach for primary and secondary repair of bladder exstrophy.
        J Urol. 1996; 155: 689
        • Berde C.B.
        • Sethna N.F.
        Analgesics for the treatment of pain in children.
        N Engl J Med. 2002; 347: 1094
        • Yaster M.
        • Kost-Byerly S.
        • Berde C.
        • et al.
        The management of opioid and benzodiazepine dependence in infants, children, and adolescents.
        Pediatrics. 1996; 98: 135
        • Gearhart J.P.
        • Ben Chaim J.
        • Sciortino C.
        • et al.
        The multiple reoperative bladder exstrophy closure: what affects the potential of the bladder?.
        Urology. 1996; 47: 240
        • Yaster M.
        • Tobin J.R.
        • Kost-Byerly S.
        Local anesthetics.
        in: Schechter N.L. Berde C.B. Yaster: M. Pain in infants, children, and adolescents. 2nd ed. Philadelphia: Lippincott Williams and Wilkins, 2003: 241
        • Lerman J.
        • Strong H.A.
        • LeDez K.M.
        • et al.
        Effects of age on the serum concentration of alpha 1-acid glycoprotein and the binding of lidocaine in pediatric patients.
        Clin Pharmacol Ther. 1989; 46: 219
        • Bosenberg A.T.
        • Thomas J.
        • Cronje L.
        • et al.
        Pharmacokinetics and efficacy of ropivacaine for continuous epidural infusion in neonates and infants.
        Paediatr Anaesth. 2005; 15: 739
        • Kost-Byerly S.
        • Tobin J.R.
        • Greenberg R.S.
        • et al.
        Bacterial colonization and infection rate of continuous epidural catheters in children.
        Anesth Analg. 1998; 86: 712
        • Burstal R.
        • Wegener F.
        • Hayes C.
        • et al.
        Subcutaneous tunnelling of epidural catheters for postoperative analgesia to prevent accidental dislodgement: a randomized controlled trial.
        Anaesth Intensive Care. 1998; 26: 147
        • Schwengel D.A.
        • McGready J.
        • Berenholtz S.M.
        • et al.
        Peripherally inserted central catheters: a randomized, controlled, prospective trial in pediatric surgical patients.
        Anesth Analg. 2004; 99: 1038