Anesthetic management of video-assisted thoracoscopic surgery (VATS) in pediatric patients: the issue of safety in infant and younger children

Background The purpose of this study was to assess the safety issues concerning anesthetic management of video-assisted thoracoscopic surgery (VATS) in pediatric patients. Methods The medical records of 52 pediatric patients undergoing VATS using general anesthesia and one-lung ventilation (OLV) were reviewed. OLV was achieved with a Fogarty catheter (n = 23) or endobronchial intubation (n = 7) in patients < 10 years of age (group Y, n = 30), and using a double-lumen tube (n = 19) or a univent (n = 3) in children aged between 10 and 16 years of age (group O, n = 22). Hypoxemia, hypercarbia, the difference between ETCO2 and PaCO2, and the effect of CO2 insufflation were assessed. Results A decrease in SpO2 less than 90% was observed in 40% of the group Y, compared to none of the group O (P < 0.05). A hypercarbia (ETCO2 > 50 mmHg) was observed more frequently in group Y (40%) than in group O (0%; P < 0.05). The difference between the ETCO2 and PaCO2 was 10.4 ± 8.9 mmHg in group Y and 4.6 ± 3.9 mmHg in group O (P < 0.05). Hypercarbia and acidosis occurred more frequently in patients with CO2 insufflation than those without insufflation in group Y. Conclusions Although the anesthesia for VATS in pediatric patients was successfully accomplished, the infants and younger children presented with more intra-operative problems when compared with older children. The anesthetic management for VATS in infants and younger children requires careful and vigilant monitoring.

[1]  G. Darling,et al.  The Use of Air in the Inspired Gas Mixture During Two-Lung Ventilation Delays Lung Collapse During One-Lung Ventilation , 2009, Anesthesia and analgesia.

[2]  A. Capek,et al.  Effect of patient weight and anesthetic technique on CO2 excretion during thoracoscopy in children assessed by end-tidal CO2. , 2008, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[3]  A. Mukhtar,et al.  The Therapeutic Potential of Intraoperative Hypercapnia During Video-Assisted Thoracoscopy in Pediatric Patients , 2008, Anesthesia and analgesia.

[4]  Jin‐Tae Kim,et al.  Simple multiport adaptor for selective lung ventilation in pediatric patients. , 2007, Anesthesia and analgesia.

[5]  C. Albanese,et al.  Experience with 144 consecutive pediatric thoracoscopic lobectomies. , 2007, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[6]  S. Baroncini,et al.  Thoracoscopy in children: anaesthesiological implications and case reports. , 2007, Minerva anestesiologica.

[7]  I. Cano,et al.  Video-assisted thoracoscopic lobectomy in infants. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[8]  D. Choudhry Single-lung ventilation in pediatric anesthesia. , 2005, Anesthesiology clinics of North America.

[9]  S. Bonner,et al.  Anaesthesia for thoracic surgery in children , 2000, Paediatric anaesthesia.

[10]  M. LaQuaglia,et al.  Bronchial injury during lung isolation in a pediatric patient. , 1998, Anesthesia and analgesia.

[11]  J. Kern,et al.  Anesthetic techniques for pediatric thoracoscopy. , 1995, The Annals of thoracic surgery.

[12]  S. Rothenberg First decade's experience with thoracoscopic lobectomy in infants and children. , 2008, Journal of pediatric surgery.

[13]  S. Eaton,et al.  Carbon dioxide elimination during laparoscopy in children is age dependent. , 2003, Journal of pediatric surgery.