Intraoperative management of a patient with a chronic, previously undiagnosed traumatic diaphragmatic hernia

Traumatic diaphragmatic hernia (TDH) occurs in approximately 5% of hospitalized motor vehicle accident victims and 10% of victims of penetrating chest injury. Although most such injuries are diagnosed at the time of initial trauma, approximately 10% become apparent only months or years later. The TDH patient is at risk for surgical complications, including pulmonary aspiration, hypoxemia, and hemodynamic instability. Diagnosis and proper management of TDH is essential in order to minimize such complications. The anesthetic management of a patient with a preexisting TDH presenting for lumbar laminectomy is discussed.