Pyloric Stenosis of Infancy-The Anaesthetic Challenge

In 1903 Dr. Freund, an early medical observer of the extraordinary condition of pyloric stenosis of infancy (PS) declared that an excess of acid was the cause [1]. This theory was quietly forgotten over the years .and the obvious acidity of the gastric contents was presumably attributed to collection of secreted acid behind a closed pylorus. Indeed when pH only is measured there is little difference. It is only when basal acid output is measured or histamine stimulated output that a huge increase in acid secretion in babies both before and after pyloromyotomy can be detected [2,3]. In more recent years compelling evidence has accumulated that hyperacidity is indeed connected to the development of this condition-it is a primary inherited constitutional condition.