{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T03:30:06Z","timestamp":1774236606459,"version":"3.50.1"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Prolonged time to extubation after general anesthesia has been defined as a delay of more than 15\u2005min 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate the frequency of \u201cdelayed extubations\u201d in infants who have received an extramucosal pyloromyotomy under general anesthesia and to identify the predictive factors of this incident.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty-four cases were collected. Delayed extubation occurred in 19 cases with very prolonged extubation (&amp;gt;60\u2005min) 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\u2005min for both groups. On the <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup> 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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1540435","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T05:31:28Z","timestamp":1751002288000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Delayed extubation and hypertrophic pyloric stenosis: what are the predictive factors?"],"prefix":"10.3389","volume":"13","author":[{"given":"Sabrine Ben","family":"Youssef","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syrine","family":"Laribi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sawsen","family":"Chakroun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maha Ben","family":"Mansour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariem Ben","family":"Fredj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afef","family":"Toumi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radhouen Ben","family":"Salah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amine","family":"Ksia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mongi","family":"Mekki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohsen","family":"Belghith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samia","family":"Belhassen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lassaad","family":"Sahnoun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1097\/01.sla.0000143250.48265.d6","article-title":"Meta-analysis of laparoscopic versus open pyloromyotomy","volume":"240","author":"Hall","year":"2004","journal-title":"Ann Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1177\/0310057X9402200108","article-title":"Postoperative apnoea in infants","volume":"22","author":"Sims","year":"1994","journal-title":"Anaest Intens Care"},{"key":"B3","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1097\/00000542-198612000-00015","article-title":"Postanesthetic apnea and periodic breathing in infants","volume":"65","author":"Welborn","year":"1986","journal-title":"Anesthesiology"},{"key":"B4","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.siny.2003.09.003","article-title":"Maturation of respiratory reflex responses in the fetus and neonate","volume":"9","author":"Abu-Shaweesh","year":"2004","journal-title":"Semin Neonatol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1111\/pan.12792","article-title":"Perioperative care of infants with pyloric stenosis","volume":"25","author":"Kamata","year":"2015","journal-title":"Pediatr Anesth"},{"key":"B6","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1097\/PEC.0b013e318209af50","article-title":"Alkalosis-induced respiratory depression from infantile hypertrophic pyloric stenosis","volume":"27","author":"Pappano","year":"2011","journal-title":"Pediatr Emerg Care"},{"key":"B7","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1097\/00000542-199401000-00031","article-title":"Postanesthetic apnea in full-term infants after pyloromyotomy","volume":"80","author":"Andropoulos","year":"1994","journal-title":"Anesthesiology"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1097\/00000539-200112000-00007","article-title":"A randomized multicenter study of remifentanil compared with halothane in neonates and infants undergoing pyloromyotomy. 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Perioperative breathing patterns in neonates and infants with pyloric stenosis","volume":"93","author":"Galinkin","year":"2001","journal-title":"Anesth Analg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1002\/(SICI)1099-0496(199904)27:4%3C278::AID-PPUL9%3E3.0.CO;2-N","article-title":"Infants undergoing pyloromyotomy are not at risk for postoperative apnea","volume":"27","author":"Chipps","year":"1999","journal-title":"Pediatr Pulmonol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2038","DOI":"10.1016\/j.jpedsurg.2008.04.008","article-title":"Predictors of emesis and time to goal intake after pyloromyotomy: analysis from a prospective trial","volume":"43","author":"St. Peter","year":"2008","journal-title":"J Pediatr Surg"},{"key":"B11","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/978-3-319-50141-3_55","article-title":"Pyloric stenosis","volume-title":"Anesthesiology","author":"Chung","year":"2017"},{"key":"B12","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.bpa.2010.04.002","article-title":"Neonatal apnoea","volume":"24","author":"Sale","year":"2010","journal-title":"Best Pract Res Clin Anaesthesiol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1540435\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T05:31:29Z","timestamp":1751002289000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1540435\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,27]]},"references-count":12,"alternative-id":["10.3389\/fped.2025.1540435"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1540435","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,27]]},"article-number":"1540435"}}