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Thoracoscopy in the pediatric patient
1Departments of Anesthesiology and Child Health, University of Missouri, Columbia, Missouri, USA. Tobiasj@health.missouri.edu
Insights
Pediatric thoracoscopy requires specific anesthetic management. This review covers anesthetic considerations for infants and children undergoing thoracoscopy, focusing on lung isolation and ventilation techniques.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Background:
- Minimally invasive thoracoscopy is increasingly used in pediatric surgery.
- Anesthetic management for pediatric thoracoscopy requires specialized knowledge.
Purpose of the Study:
- To review anesthetic care for pediatric thoracoscopy.
- To highlight key considerations for perioperative management.
Main Methods:
- Review of current literature on pediatric thoracoscopy anesthesia.
- Emphasis on cardiopulmonary disturbances and ventilation techniques.
Main Results:
- Cardiopulmonary alterations due to pneumothorax and CO2 absorption.
- Techniques for one-lung ventilation (OLV) are crucial for surgical visualization.
- Management of inadvertent CO2 embolism is essential.
Conclusions:
- Optimized anesthetic strategies are vital for safe pediatric thoracoscopy.
- Understanding and managing cardiopulmonary effects of OLV and CO2 are critical.
Abstract:
The pediatric applications of minimally invasive surgical procedures such as thoracoscopy continue to increase. Specific alterations in anesthetic management may be required during the perioperative care of these patients. This article reviews the anesthetic care of infants and children during thoracoscopy with emphasis on cardiopulmonary disturbances of the patient, techniques to isolate the operative and nonoperative lungs and provide one-lung ventilation to improve surgical visualization, cardiopulmonary alterations induced by the creation of the artificial pneumothorax or the absorption of CO2 by the plural surface, intraoperative management of one-lung ventilation, and the potential for and treatment of inadvertent CO2 embolism.