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Canadian Journal of Anesthesia, Vol 42, 808-812, Copyright © 1995 by Canadian Anesthesiologists' Society

ARTICLES

Anaesthetic management of a child with Bartter's syndrome

S Kannan, Y Delph and HS Moseley
Department of Anaesthesia and Surgical Intensive Care, Queen Elizabeth Hospital, Barbados, West Indies.

We report the anaesthetic management of an eight-year-old asthmatic boy with Bartter's syndrome who had bilateral orchidopexy with caudal epidural analgesia. Bartter's syndrome is a rare congenital disorder characterized by hypokalaemic hypochloraemic metabolic alkalosis, hyperaldosteronism, hyperreninaemia and hyperplasia of the juxtaglomerular apparatus of the kidneys. Characteristically, although these patients are normotensive they may be hypovolaemic. They may have unstable baroreceptor responses and show marked resistance to vasopressors. Hence, fluid, acid-base and electrolyte imbalances along with haemodynamic instability pose particular problems in their anaesthetic management. Previous case reports have described the management of these patients with general anaesthesia, our patient had his orchidopexy with caudal epidural analgesia using plain bupivacaine 0.5%. The patient was haemodynamically stable throughout surgery and was comfortable with caudal analgesia as the sole anaesthetic. Hypovalaemia, acid-base status and electrolyte imbalance were treated before instituting caudal epidural analgesia. We present this case report which describes the anaesthetic considerations in the light of the pathophysiology of Bartter's syndrome.


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I. Amirlak and K.P. Dawson
Bartter syndrome: an overview
QJM, April 1, 2000; 93(4): 207 - 215.
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Copyright © 1995 by the Canadian Anesthesiologists' Society.