ANESTHETIC MANAGEMENT OF A CHILD WITH BARTTERS-SYNDROME

We report the anaesthetic management of an eight-year-old asthmatic bo y with Bartter's syndrome who had bilateral orchidopexy with caudal ep idural analgesia. Bartter's syndrome is a rare congenital disorder cha racterized by hypokalaemic hypochloraemic metabolic alkalosis hyperald osteronism, hyperreninaemia and hyperplasia of the juxtaglomerular app aratus of the kidneys. Characteristically, although these patients are normotensive they may be hypovolaemic. They may have unstable barorec eptor responses and show marked resistance to vasopressors. Hence, flu id, acid-base and electrolyte imbalances along with haemodynamic insta bility pose particular problems in their anaesthetic management. Previ ous case reports have described the management of these patients with general anaesthesia, our patient had his orchidopexy with caudal epidu ral analgesia using plain bupivacaine 0.5%. The patient was haemodynam ically stable throughout surgery and was comfortable with caudal analg esia as the sole anaesthetic. Hypovalaemia, acid-base status and elect rolyte imbalance were treated before instituting caudal epidural analg esia. We present this care report which describes the anaesthetic cons iderations in the light of the pathophysiology of Bartter's syndrome.