Mohamad A. Omar, Tamer Ghoneim, Hind Khaleel
Emirates Health Services.
United Arab Emirates
Cureus
Cureus 2024; 16:
DOI: 10.7759/cureus.75506
Abstract
Congenital diaphragmatic hernia (CDH) presents significant challenges in neonatal management, particularly in the context of anesthesia. This case report details the successful anesthetic management of a five-day-old neonate with left-sided CDH requiring thoracoscopic repair. A five-day-old neonate, delivered via emergency cesarean section due to breech presentation, presented with severe respiratory distress and was diagnosed with left-sided CDH. Initial evaluation revealed respiratory acidosis and moderate pulmonary hypertension. Preoperative stabilization included high-frequency oscillatory ventilation and intravenous infusions of milrinone and vasopressin. Induction was achieved with ketamine and midazolam, along with a left-sided erector spinae block for analgesia. Anesthesia was maintained with intermittent fentanyl boluses during the eight-hour surgery. Ventilation was closely monitored and adjusted for changes in carbon dioxide levels. The surgery was successful, with stable hemodynamics and a smooth recovery. Effective anesthesia in neonates with CDH requires careful preoperative planning and intraoperative vigilance. This case underscores the importance of tailored anesthetic strategies to enhance safety and promote recovery in high-risk pediatric surgeries.
Category
Class III. Pulmonary Hypertension Associated with Lung Hypoplasia
Procedural Risk and Care for Individuals with Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes