Anaesthetic implications of paediatric thoracoscopy

Abstract

Anaesthetic care during thoracic surgical procedures in children combines components of the knowledge bases of paediatric anaesthesia with those of thoracic anaesthesia. This article highlights the principles of anaesthesia during thoracoscopic surgery in children including preoperative evaluation, anaesthetic induction techniques, maintenance anaesthesia and options for postoperative analgesia. In addition, given the need to provide optimal surgical visualization during the procedure, one lung ventilation may be required. Techniques to provide one lung ventilation in the paediatric patient and the principles of anaesthesia care during one lung ventilation are discussed.

Bovine thoracoscopy: Surgical technique and normal anatomy

“…One cow had mild coughing during insufflation; however, this ceased when negative pressure was reestablished. Several reports describe coughing during thoracoscopic interventions in horses and people . We recommend use of cannulas with a side stopcock, to which a suction tube can be attached to facilitate rapid control of intrapleural pressure and relief of pneumothorax if needed.…”

Challenges in Anaesthetic management of a child for thoracoscopic assisted oesophageal replacement

“…Performing this procedure by minimally invasive technique appears to be a promising approach to offer these children an acceptable quality of life. [ 5 ] On the other, anaesthesia for paediatric thoracoscopy needs experience in various techniques of providing OLV and utmost vigilance to detect intra-operative complications such as arrhythmias, hypoxia, hypercarbia and atelectasis that needs early detection and appropriate treatment. [ 5 ] Hypoxia and hypercarbia are more common in infants and younger children because of ventilation perfusion mismatch.…”

The use of lung ultrasonography to confirm lung isolation in an infant who underwent emergent video-assisted thoracoscopic surgery: a case report

“…Traditionally, lung auscultation [ 5 ], chest wall observation [ 5 ], fiberoptic bronchoscopy [ 1 ], chest radiography, and fluoroscopy [ 6 ] have been used to confirm proper lung isolation. Auscultation and chest wall observation are simple techniques and require no special equipment, but are not reliable methods [ 5 ].…”

“…With advances in technology, minimally invasive thoracoscopic procedures in infants and children are gaining popularity. Although thoracoscopic surgery can be performed without lung isolation, the operative-sided lung should be isolated in some cases, because one-lung ventilation ensures good surgical conditions and low incidence of accidental lung injury [ 1 ]. Confirmation of lung isolation before surgery is therefore important to provide an adequate operative field during surgery.…”