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Article: Anesthetic management of thoracoscopic resection of lung lesions in small children

TitleAnesthetic management of thoracoscopic resection of lung lesions in small children
Authors
Keywordsbronchial blocker
congenital lung lesions
one‐lung ventilation
remifentanil
small children
Issue Date2018
PublisherBlackwell Publishing Ltd. The Journal's web site is located at https://onlinelibrary.wiley.com/journal/14609592
Citation
Paediatric Anaesthesia, 2018, v. 28 n. 11, p. 1035-1042 How to Cite?
AbstractBackground: Video‐assisted thoracoscopic surgery has dramatically increased over the last decade because of both medical and cosmetic benefits. Anesthesia for video‐assisted thoracoscopic surgery in small children is more challenging compared to adults due to the considerable problems posed by small airway dimensions and ventilation. The optimal technique for one‐lung ventilation has yet to be established and the use of remifentanil infusion in this setting is not well described. Aims: This study investigated the use of extraluminal bronchial blocker placement for one‐lung ventilation and the effect of infusion of remifentanil in infants and small children undergoing video‐assisted thoracoscopic surgery. Methods: We retrospectively reviewed the technique of one‐lung ventilation and the hemodynamic effects of remifentanil infusion in 31 small children during elective video‐assisted thoracoscopic surgery for congenital lung lesions under anesthesia with sevoflurane or isoflurane, oxygen, and air. Patients’ heart rate, blood pressure, and endtidal carbon dioxide at baseline (after induction of anesthesia), immediately after one‐lung ventilation, during carbon dioxide insufflation, and at the end of one‐lung ventilation were extracted from the database and analyzed. The use of vasopressors or dexmedetomidine was also recorded and analyzed. Results; Extraluminal placement of a bronchial blocker alongside the tracheal tube was successfully performed in 90.3% of cases (28 patients) without any serious complications or arterial oxygen desaturation. There was no significant rise in blood pressure or heart rate even with the rise of endtidal carbon dioxide concentration during video‐assisted thoracoscopic surgery. In 58% of patients (18 patients), phenylephrine was administered to maintain the blood pressure within 20% of the baseline value. There was no significant change in the heart rate of all patients at each time point. Conclusion: One‐lung ventilation with an extraluminal parallel blocker was used effectively in this series of young children undergoing thoracoscopic excision of congenital pulmonary lesions. Remifentanil infusion attenuated surgical stress effectively in infants and small children undergoing video‐assisted thoracoscopic surgery.
Persistent Identifierhttp://hdl.handle.net/10722/272813
ISSN
2020 Impact Factor: 2.556
2020 SCImago Journal Rankings: 0.704
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorMohtar, S-
dc.contributor.authorHui, TWC-
dc.contributor.authorIrwin, MG-
dc.date.accessioned2019-08-06T09:17:02Z-
dc.date.available2019-08-06T09:17:02Z-
dc.date.issued2018-
dc.identifier.citationPaediatric Anaesthesia, 2018, v. 28 n. 11, p. 1035-1042-
dc.identifier.issn1155-5645-
dc.identifier.urihttp://hdl.handle.net/10722/272813-
dc.description.abstractBackground: Video‐assisted thoracoscopic surgery has dramatically increased over the last decade because of both medical and cosmetic benefits. Anesthesia for video‐assisted thoracoscopic surgery in small children is more challenging compared to adults due to the considerable problems posed by small airway dimensions and ventilation. The optimal technique for one‐lung ventilation has yet to be established and the use of remifentanil infusion in this setting is not well described. Aims: This study investigated the use of extraluminal bronchial blocker placement for one‐lung ventilation and the effect of infusion of remifentanil in infants and small children undergoing video‐assisted thoracoscopic surgery. Methods: We retrospectively reviewed the technique of one‐lung ventilation and the hemodynamic effects of remifentanil infusion in 31 small children during elective video‐assisted thoracoscopic surgery for congenital lung lesions under anesthesia with sevoflurane or isoflurane, oxygen, and air. Patients’ heart rate, blood pressure, and endtidal carbon dioxide at baseline (after induction of anesthesia), immediately after one‐lung ventilation, during carbon dioxide insufflation, and at the end of one‐lung ventilation were extracted from the database and analyzed. The use of vasopressors or dexmedetomidine was also recorded and analyzed. Results; Extraluminal placement of a bronchial blocker alongside the tracheal tube was successfully performed in 90.3% of cases (28 patients) without any serious complications or arterial oxygen desaturation. There was no significant rise in blood pressure or heart rate even with the rise of endtidal carbon dioxide concentration during video‐assisted thoracoscopic surgery. In 58% of patients (18 patients), phenylephrine was administered to maintain the blood pressure within 20% of the baseline value. There was no significant change in the heart rate of all patients at each time point. Conclusion: One‐lung ventilation with an extraluminal parallel blocker was used effectively in this series of young children undergoing thoracoscopic excision of congenital pulmonary lesions. Remifentanil infusion attenuated surgical stress effectively in infants and small children undergoing video‐assisted thoracoscopic surgery.-
dc.languageeng-
dc.publisherBlackwell Publishing Ltd. The Journal's web site is located at https://onlinelibrary.wiley.com/journal/14609592-
dc.relation.ispartofPaediatric Anaesthesia-
dc.rightsThe definitive version is available at www.blackwell-synergy.com-
dc.subjectbronchial blocker-
dc.subjectcongenital lung lesions-
dc.subjectone‐lung ventilation-
dc.subjectremifentanil-
dc.subjectsmall children-
dc.titleAnesthetic management of thoracoscopic resection of lung lesions in small children-
dc.typeArticle-
dc.identifier.emailHui, TWC: huitwc@hkucc.hku.hk-
dc.identifier.emailIrwin, MG: mgirwin@hku.hk-
dc.identifier.authorityIrwin, MG=rp00390-
dc.description.naturepostprint-
dc.identifier.doi10.1111/pan.13502-
dc.identifier.pmid30281181-
dc.identifier.scopuseid_2-s2.0-85054406587-
dc.identifier.hkuros299964-
dc.identifier.volume28-
dc.identifier.issue11-
dc.identifier.spage1035-
dc.identifier.epage1042-
dc.identifier.isiWOS:000449552500013-
dc.publisher.placeUnited Kingdom-
dc.identifier.issnl1155-5645-

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