Challenges in the Anaesthetic Management of Congenital Diaphragmatic Hernia in a Tertiary Care Children Hospital of Nepal

Regmi S*, Baral BK**, Sapkota S*** ,

Abstract


Introduction: Congenital diaphragmatic hernias (CDH) are complex developmental anomaly. It results from anomalous closure of pericardio-peritoneal canal. Consequently, abdominal organs extrude into the thoracic cavity, impairing the growth of the ipsilateral lung. Surgical correction is the only treatment modality. There are various challenges faced by anesthesiologists such as hypoxia and hypercarbia leading to pulmonary hypertension and right to left shunt. This study is carried out to present perioperative complications that we faced during the anaesthetic management of CDH in patients who underwent surgical closure of the diaphragmatic defect in a tertiary care centre of Nepal.

Method: This is a retrospective study carried over a period of one year. We reviewed the medical records of children with the diagnosis of CDH who underwent surgical correction of diaphragmatic defect. The perioperative complications were recorded as the appearance of bradycardia, hypoxia, sepsis, DIC, pneumothorax and the collected data were analyzed.

Result: Thirteen children presented to the hospital with the diagnosis of CDH and underwent surgical repair. Among them, 9 (69.23%) were male and 4 (30.76%) were female. Hospital presentation on 8 to 30 days of life was noted in 46.15% of the cases, The most common complication during the perioperative period was hypoxia, bradycardia and pneumothorax. The survival rate was 61.53%.

Conclusion: The anaesthetic management of CDH is still a difficult and challenging for anaesthesiologist. Bradycardia, hypoxia, pneumothorax, septicemia and DIC are the major causes of perioperative morbidity and mortality. Preoperative optimization and gentle ventilation strategy makes significant impact on survival in child.

Keywords: Congenital diaphragmatic hernia, hypoxia, pul

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