Youssef Sabrine Ben, Laribi Syrine, Chakroun Sawsen, Mansour Maha Ben, Fredj Mariem Ben, Toumi Afef, Salah Radhouen Ben, Ksia Amine, Mekki Mongi, Belghith Mohsen, Belhassen Samia, Sahnoun Lassaad
Department of Pediatric Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia.
Department of Anaesthesia and Intensive Care, Fattouma Bourguiba Hospital, Monastir, Tunisia.
Front Pediatr. 2025 Jun 27;13:1540435. doi: 10.3389/fped.2025.1540435. eCollection 2025.
Prolonged time to extubation after general anesthesia has been defined as a delay of more than 15 min from the end of surgery to tracheal extubation. This incident is frequently seen in infants operated on for hypertrophic pyloric stenosis (HPS), which can lead to inefficient use of operating rooms and delayed care for other patients.
To evaluate the frequency of "delayed extubations" in infants who have received an extramucosal pyloromyotomy under general anesthesia and to identify the predictive factors of this incident.
We report a retrospective and comparative study of patients operated for HPS at the pediatric surgery department of Monastir, between January 2020 and December 2023.
Thirty-four cases were collected. Delayed extubation occurred in 19 cases with very prolonged extubation (>60 min) in 3 cases. The mean age at diagnosis was 38.07 days for group 1 and 34.42 days for group 2. The average of operating time was 56 min for both groups. On the test, the difference between the groups was significant for metabolic alkalosis. However, the results were not significant for the other criteria (prematurity, hypotrophy, dehydration, hyponatremia, hypochloremia, hypokalemia, functional renal failure, pre-operative resuscitation time).
These data suggest that metabolic alkalosis is predictive of delayed extubation in infants operated on for HPS under general anesthesia. The use of spinal anesthesia may be an alternative to general anesthesia but it remains a controversial issue, as there are few comparative data.
全身麻醉后拔管时间延长被定义为从手术结束到气管拔管延迟超过15分钟。这种情况在接受肥厚性幽门狭窄（HPS）手术的婴儿中经常出现，这可能导致手术室使用效率低下，并延误其他患者的治疗。
评估全身麻醉下接受黏膜外幽门肌切开术的婴儿中“延迟拔管”的发生率，并确定该事件的预测因素。
我们报告了一项对2020年1月至2023年12月在莫纳斯提尔儿科外科接受HPS手术患者的回顾性比较研究。
共收集到34例病例。19例发生延迟拔管，其中3例拔管时间极长（>60分钟）。第1组诊断时的平均年龄为38.07天，第2组为34.42天。两组的平均手术时间均为56分钟。在检验中，两组之间代谢性碱中毒的差异具有统计学意义。然而，在其他标准（早产、发育不良、脱水、低钠血症、低氯血症、低钾血症、功能性肾衰竭、术前复苏时间）方面，结果无统计学意义。
这些数据表明，代谢性碱中毒是全身麻醉下接受HPS手术的婴儿延迟拔管的预测因素。使用脊髓麻醉可能是全身麻醉的一种替代方法，但由于比较数据较少，这仍然是一个有争议的问题。
