Anesthetic management of gastrochisis--a review of our practice over the past 5 years.

BACKGROUND: Surgical closure of gastrochisis has traditionally been performed under general anesthesia followed by admission to intensive care and postoperative ventilation. We reviewed the management of these neonates in our hospital over the past 5 years to identify changes in practice and possible factors which affect the perioperative course.
METHODS: We retrospectively identified cases of gastrochisis undergoing repair from June 2002 to May 2007. Details of the demographic data, preoperative factors, intraoperative anesthetic and surgical management and postoperative care were collected from the anesthetic chart, operative record and patient notes.
RESULTS: Forty-eight self-ventilating neonates underwent operative repair in theatre. A neuraxial local anesthetic block was performed as part of the anesthetic technique in 22 patients. There was a significant difference in the need for postoperative ventilation in this group (23%) when compared with a traditional opioid-based method of providing analgesia (88%, P < 0.05). This difference was seen in both term and preterm babies.
CONCLUSION: Conclusions are difficult when analyzing retrospective data in patients with a variety of factors. The results suggest that anesthesia which includes a regional technique is a valid method in these cases. Traditional opioid analgesia when compared to regional techniques may be associated with increased need for postoperative ventilation.