Abstract
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.
Highlights
Congenital diaphragmatic hernia (CDH) is a rare condition (1/2500 births) that overall has a high mortality rate ranging between 42% and 68%
We aim to present our intra-operative experience in a 4days old neonate with severe lung hypoplasia under ventilatory treatment with high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide combination
A 38 weeks of gestational age, 3070gram newborn male was admitted to neonatal intensive care unit (NICU) and intubated due to severe respiratory insufficiency
Summary
Congenital diaphragmatic hernia (CDH) is a rare condition (1/2500 births) that overall has a high mortality rate ranging between 42% and 68%.1 Pulmonary hypoplasia, pulmonary hypertension and respiratory insufficiency are the factors that make perioperative management of the patients with CDH challenging.[1]. Congenital diaphragmatic hernia (CDH) is a rare condition (1/2500 births) that overall has a high mortality rate ranging between 42% and 68%.1. Pulmonary hypertension and respiratory insufficiency are the factors that make perioperative management of the patients with CDH challenging.[1] During the perioperative management of these patients, the conventional ventilation strategies may be inadequate. For neonates with CDH with low ventilation volumes, high-frequency oscillatory ventilation (HFOV) is a safe and effective choice as it provides better gas exchange and less volutrauma.[2] In this report, we aim to present our intra-operative experience in a 4days old neonate with severe lung hypoplasia under ventilatory treatment with HFOV and inhaled nitric oxide (iNO) combination
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