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Murray-Torres TM, Winch PD, Naguib AN, Tobias JD. Anesthesia for thoracic surgery in infants and children. Saudi J Anaesth 2021; 15:283-299. [PMID: 34764836 PMCID: PMC8579498 DOI: 10.4103/sja.sja_350_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022] Open
Abstract
The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management.
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Affiliation(s)
- Teresa M Murray-Torres
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peter D Winch
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Aymen N Naguib
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, Missouri, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Kozlov Y, Novozhilov V. Thoracoscopic Plication of the Diaphragm in Infants in the First 3 Months of Life. J Laparoendosc Adv Surg Tech A 2015; 25:342-7. [DOI: 10.1089/lap.2014.0205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yury Kozlov
- Department of Neonatal Surgery, Municipal Pediatric Hospital, Irkutsk, Russia
- Department of Pediatric Surgery, Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia
- Department of Pediatric Surgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Vladimir Novozhilov
- Department of Neonatal Surgery, Municipal Pediatric Hospital, Irkutsk, Russia
- Department of Pediatric Surgery, Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia
- Department of Pediatric Surgery, Irkutsk State Medical University, Irkutsk, Russia
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Miyano G, Yamoto M, Kaneshiro M, Miyake H, Morita K, Nouso H, Koyama M, Okawada M, Doi T, Koga H, Fukumoto K, Lane GJ, Yamataka A, Urushihara N. Diaphragmatic eventration in children: laparoscopy versus thoracoscopic plication. J Laparoendosc Adv Surg Tech A 2015; 25:331-4. [PMID: 25760817 DOI: 10.1089/lap.2014.0237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM To determine the best way to perform diaphragmatic plication for diaphragmatic eventration (DE) using minimally invasive surgery. MATERIALS AND METHODS We conducted a retrospective review of pediatric cases of DE treated between 2007 and 2012. Thoracoscopic plication (TP) is performed using single-lung ventilation with three 5-mm ports; laparoscopic plication (LP) is performed using three or four 5-mm ports. The choice of technique was determined preferentially by the treating surgeon. RESULTS There were 20 subjects (13 treated by LP and 7 treated by TP). Etiology of DE was phrenic nerve injury (LP, n=11; TP, n=1) and muscular deficiency (LP, n=2; TP, n=6). Mean age (LP, 18 months; TP, 25 months) and weight (LP, 8.0 kg; TP, 9.7 kg) at surgery were not significantly different. Mean operating time was 155.6 minutes in LP and 167.0 minutes in TP (P=not significant). Mean intraoperative end-tidal CO2 was 41.9 mm Hg (range, 35-52 mm Hg) in LP and 36.9 mm Hg (range, 33-41 mm Hg) in TP (P=.01). Mean duration of postoperative ventilation was 1.2 days in LP and 1.3 days in TP (P=not significant). Mean time taken to recommence feeding postoperatively was 1.6 days in both groups (P=not significant). Complications were one conversion to thoracotomy in TP, 1 case of atelectasis in each group (P=not significant), and 6 cases of recurrence in LP versus none in TP (P=.04). CONCLUSIONS Both TP and LP are beneficial for treating small children with DE. However, there is a higher incidence of recurrence after LP, and the role of TP in cardiac patients requiring subsequent surgery is debatable.
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Affiliation(s)
- Go Miyano
- 1 Department of Pediatric Surgery, Shizuoka Children's Hospital , Shizuoka, Japan
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Tanaka Y, Uchida H, Kawashima H, Sato K, Takazawa S, Masuko T, Deie K, Iwanaka T. Complete Thoracoscopic Versus Video-Assisted Thoracoscopic Resection of Congenital Lung Lesions. J Laparoendosc Adv Surg Tech A 2013; 23:719-22. [DOI: 10.1089/lap.2013.0110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yujiro Tanaka
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kaori Sato
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Shinya Takazawa
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Takayuki Masuko
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kyoichi Deie
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, University of Tokyo Hospital, Tokyo, Japan
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Takahashi T, Okazaki T, Ochi T, Nishimura K, Lane GJ, Inada E, Yamataka A. Thoracoscopic plication for diaphragmatic eventration in a neonate. Ann Thorac Cardiovasc Surg 2012; 19:243-6. [PMID: 22971706 DOI: 10.5761/atcs.cr.12.01907] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Currently, thoracoscopic surgery is replacing thoracotomy for an ever increasing number of indications, even in pediatric surgery. However, there are few reports describing thoracoscopic plication (TP) for diaphragmatic eventration in children, particularly in neonates. We report a case of TP under single-lung ventilation in a neonate with diaphragmatic eventration. CASE REPORT A 10-day-old boy was referred for surgical management of right diaphragmatic eventration. Birth was at term, following an uncomplicated pregnancy and delivery. Shortness of breath, labored respiration and chest retraction presented soon after birth, necessitating mechanical ventilation. Chest radiography and computed tomography revealed an elevated right hemidiaphragm. Attempted weaning off mechanical ventilation failed with persistence of respiratory symptoms, requiring nasal directional positive airway pressure. However, because there was no resolution of symptoms, TP was performed using a 3 port technique under single-lung ventilation on day 17 of life. The postoperative course was excellent with complete resolution of respiratory symptoms with no recurrence for 9 months. CONCLUSION To the best of our knowledge, this is the youngest case of TP for diaphragmatic eventration performed under single-lung ventilation. TP is safe, effective and minimally invasive and should be considered actively for the treatment of symptomatic diaphragmatic eventration even in neonates.
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Affiliation(s)
- Tsubasa Takahashi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
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Thomas RJ, Kishore R, Kisku S. A helping clamp for thoracoscopic plication of eventration of the diaphragm. J Indian Assoc Pediatr Surg 2011; 16:97-8. [PMID: 21897568 PMCID: PMC3160062 DOI: 10.4103/0971-9261.83486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background and Aim: It is difficult to suture an extremely thin and billowed up congenital eventration of the diaphragm thoracoscopically, without insufflation. Materials and Methods: The authors describe their technique using an intestinal clamp to control the redundant tissue and a feeding tube as a flexible knot pusher, to perform the thoracoscopic plication without risking hypercapnia. Results: A satisfactory result was obtained in all the four children. Conclusion: This is a useful adjunctive for thoracoscopic plication of diaphragmatic eventration.
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Affiliation(s)
- Reju Joseph Thomas
- Department of Pediatric Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Liem NT, Nhat LQ, Tuan TM, Dung LA, Ung NQ, Dien TM. Thoracoscopic repair for congenital diaphragmatic hernia: experience with 139 cases. J Laparoendosc Adv Surg Tech A 2011; 21:267-70. [PMID: 21204646 DOI: 10.1089/lap.2010.0106] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To analyze indications and to present details of surgical technique and outcomes of thoracoscopic repair for congenital diaphragmatic hernia (CDH) in 139 patients. METHODS We reviewed medical records of all patients with CDH who underwent thoracoscopic repair by the same surgical team from June 2001 to October 2009. Patients were placed in the lateral decubitus position. The operations were performed using three trocars. Pleural insufflation with carbon dioxide was maintained at a pressure of 2-6 mm Hg. The hernia defect was repaired using nonabsorbable interrupted sutures with extracorporeal knots. A prosthetic patch was used when direct closure of the hernia defect was not feasible. RESULTS There were 139 patients, including 91 boys and 48 girls. Seventy-five patients were newborns, and 64 were infants or children. The hernia was located on the left side in 113 patients (81.3%) and on the right side in 26 patients (18.7%). The mean operative time for thoracoscopic approach was 66 ± 27 minutes. Conversion was required in 11 patients (7.9%) from 2001 to 2007. There were no conversions in 2008 or 2009. A prosthetic patch was used in 7 patients. There were 14 postoperative deaths (10%). Follow-up was obtained in 114 patients, ranging from 1 to 84 months (mean 26.3 ± 24.7 months). Five patients had recurrence (3.6%). CONCLUSIONS Thoracoscopic repair is feasible and safe for children with CDH, including newborns. The conversion rate decreased, and indications increased with surgical team experience.
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Affiliation(s)
- Nguyen Thanh Liem
- Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam.
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Liem NT, Dien TM, Ung NQ. Thoracoscopic repair in the neonatal intensive care unit for congenital diaphragmatic hernia during high-frequency oscillatory ventilation. J Laparoendosc Adv Surg Tech A 2010; 20:111-4. [PMID: 19432532 DOI: 10.1089/lap.2008.0412] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM The aim of this work was to report the technique and result of thoracoscopic repair for a newborn with congenital diaphragmatic hernia (CDH) under high-frequency oscillatory ventilation (HFOV) in the neonatal intensive care unit (NICU). METHODS Ventilation was supported by HFOV. The patient was placed in the right lateral decubitus position. Thoracoscopic surgery was performed through three 5-mm trocars. Carbon dioxide insufflation was maintained in the thoracic cavity at a pressure of 6-8 mm Hg. The hernia defect was repaired by using interrupted sutures with extracorporeal knots. RESULTS The operation lasted 60 minutes. The intraoperative course was uneventful. Normal vital signs and PO(2) value were maintained throughout the operation. The patient had a normal chest X-ray 1 month after discharge. CONCLUSION Thoracoscopic repair of CDH in the NICU during HFOV is feasible and safe.
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Affiliation(s)
- Nguyen T Liem
- Department of Surgery, National Hospital of Pediatrics, Dong Da District, Hanoi, Vietnam.
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Szavay PO, Drews K, Fuchs J. Thoracoscopic Repair of a Right-Sided Congenital Diaphragmatic Hernia. Surg Laparosc Endosc Percutan Tech 2005; 15:305-7. [PMID: 16215495 DOI: 10.1097/01.sle.0000183253.04432.1d] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presentation of a congenital diaphragmatic hernia (CDH) beyond infancy is rare, as it is a common cause for severe respiratory distress in the newborn. In contrast to the newborn period, delayed diagnosis of right-sided congenital diaphragmatic hernia (RCDH) is known as it causes less severe symptoms than left-sided CDH. A case of an 8-month-old girl is reported. Chest x-ray and ultrasound examination of the diaphragm for symptoms of pneumonia revealed an RCDH. Thoracoscopic repair could be performed. The further course was uneventful. Thoracoscopic repair of a RCDH proved in this case to be feasible and safe beyond the newborn period. It avoided the morbidity of a major thoracotomy or laparotomy and provided an excellent cosmetic result. To our knowledge, this is the first report of thoracoscopic repair of RCDH.
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Affiliation(s)
- Philipp O Szavay
- Department of Pediatric Surgery, Children's Hospital, University of Tuebingen, Tuebingen, Germany.
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