Anesthetic Management of a Neonate with Congenital Diaphragmatic Hernia under High-Frequency Oscillatory Ventilation

Perioperative management of a neonate with congenital diaphragmatic hernia (CDH) is challenging because of pulmonary hypoplasia, pulmonary hypertension, and respiratory insufficiency. In this report, we present our intra-operative experience in a 4-days old and 3070 grams CDH neonate. He was admitte...

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Bibliographic Details
Published in:Clinics and practice 2018-06, Vol.8 (2), p.1057
Main Authors: Edipoglu, Ipek S., Celik, Fatma, Ozdogan, Tutku, Comert, Serdar, Guvenc, B. Haluk
Format: Article
Language:English
Subjects:
Case Report
Congenital
diaphragmatic
hernia
high-frequency
oscillatory
ventilation
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Summary:Perioperative management of a neonate with congenital diaphragmatic hernia (CDH) is challenging because of pulmonary hypoplasia, pulmonary hypertension, and respiratory insufficiency. In this report, we present our intra-operative experience in a 4-days old and 3070 grams CDH neonate. He was admitted to neonatal intensive care unit and intubated due to severe respiratory insufficiency. He showed signs of severe pulmonary hypoplasia and his echocardiography revealed a cardiac dextroversion. The patient was relatively stabilized after four days under combined high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (iNO). A corrective surgical intervention was sustained with dopamine, dobutamine, fentanyl and midazolam infusions. Ventilator settings were: 9 cmH2O MAP; 15-Hz frequency; 30 cmH2O amplitude and 55% FiO2. Venous-blood gas analysis indicated pH:7.38 pO2:36.2, pCO2:39.2 with SpO2:98%. We believe that HFOV and iNO combination is an effective alternative for the anesthetic management of CDH cases as it provides better gas exchange and less volutrauma.
ISSN:2039-7283
2039-7275
2039-7283
DOI:10.4081/cp.2018.1057