TYK375

The surgeon calls you at 3 a.m. about a 2 month-old boy who has IHPS, diagnosed by history and ultrasound. He feels this is an emergent case given the infant’s vomiting, metabolic derangement, and dehydration. You see the infant in the ER, and the parents also feel strongly about taking their child to the OR. You determine the BEST course of action is to:

a) Allow the child to continue oral intake for rehydration and delay the case until morning

b) Delay the case until the infant has been medically stabilized and laboratory data are close to normal

c) Proceed with the case, explaining the risks of rapid sequence induction to the parents

d) Proceed with the case, but insist on a 20 mL/kg bolus of normal saline prior to starting

e) Proceed with the case, but ensure awake suctioning of the stomach prior to induction of anesthesia

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Answer

Answer b. IHPS is a medical emergency, not a surgical emergency. The best course of action is to rehydrate the infant with intravenous fluids (oral hydration will prompt continuing emesis); ensure medical stabilization, fluid resuscitation, and improvement of his metabolic state; and then proceed with surgery.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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