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Published on: January 17, 2011
Anesthetic techniques for pediatric thoracoscopy
E D McGahren1, J A Kern, B M Rodgers
1Department of Surgery, University of Virginia Health Sciences Center, Charlottesville.
Insights
Regional anesthesia is best for older children undergoing thoracoscopic procedures. General anesthesia with two-lung ventilation is safest for infants and young children, while one-lung ventilation suits adolescents.
Area of Science:
- Pediatric Anesthesiology
- Thoracic Surgery
- Critical Care Medicine
Background:
- 68 thoracoscopic procedures were performed in 62 pediatric patients (7 months to 21 years) since 1981.
- Review focused on anesthetic and ventilation strategies for safety and efficacy in specific pediatric populations and conditions.
Purpose of the Study:
- To evaluate the safety and effectiveness of different anesthetic and ventilation strategies in pediatric thoracoscopic surgery.
- To guide the selection of appropriate anesthetic techniques based on patient age and clinical condition.
Main Methods:
- Retrospective review of anesthetic and ventilation strategies for 68 thoracoscopic procedures.
- Analysis of patient age, procedure type, and anesthetic approach (regional vs. general anesthesia with one-lung or two-lung ventilation).
Main Results:
- Regional anesthesia with sedation was used in 5 older patients (9-21 years); one required conversion to general anesthesia.
- General anesthesia with one-lung ventilation (OLV) was used in 17 patients (7 months-18 years); two required conversion to two-lung anesthesia (TLA) due to intolerance, and three ultimately needed thoracotomy.
- General anesthesia with two-lung ventilation (TLA) was employed in 41 patients (1-17 years) with no anesthesia-related complications.
Conclusions:
- Regional anesthesia is suitable for older, cooperative pediatric patients.
- General anesthesia with one-lung ventilation is effective for adolescents, especially for mediastinal procedures and talc pleurodesis.
- General anesthesia with two-lung ventilation is a versatile option, essential for infants and small children, and beneficial for older patients with severe pulmonary compromise.
Background:
Since 1981, we have performed 68 thoracoscopic procedures in 62 patients aged 7 months to 21 years.
Methods:
We reviewed the anesthetic and ventilation strategy used for each procedure to determine which anesthetic strategies are safe and effective for particular children and conditions.
Results:
Regional anesthesia with sedation was used for six procedures in 5 patients with a mean age of 16 years (range, 9 to 21 years). One patient required conversion to general anesthesia. General anesthesia with one-lung ventilation was attempted for 18 procedures in 17 patients with a mean age of 12 years (range, 7 months to 18 years). Two patients required conversion to two-lung anesthesia secondary to pulmonary intolerance. One of these patients and 2 others required thoracotomy. General anesthesia with two-lung ventilation was used for 44 procedures in 41 patients with a mean age of 9 years (range, 1 to 17 years). There were no anesthesia-related difficulties.
Conclusions:
Regional anesthesia should be limited to the older, more cooperative patient. General anesthesia with one-lung ventilation is useful in adolescents, as they tolerate collapse of one lung well, and it is particularly desirable for procedures requiring exposure of the mediastinum and for talc pleurodesis. General anesthesia with two-lung ventilation can be used in any age group but is generally necessary for infants and small children, as they often will not tolerate the collapse of one lung, and in the larger child or adolescent with severe pulmonary compromise.
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