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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| Format: | Article |
| Language: | English |
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MDPI AG
2018-06-01
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| Series: | Clinics and Practice |
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| Online Access: | https://www.clinicsandpractice.org/index.php/cp/article/view/1057 |
| _version_ | 1798025140821295104 |
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| author | Ipek S. Edipoglu Fatma Celik Tutku Ozdogan Serdar Comert B. Haluk Guvenc |
| author_facet | Ipek S. Edipoglu Fatma Celik Tutku Ozdogan Serdar Comert B. Haluk Guvenc |
| author_sort | Ipek S. Edipoglu |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T18:13:55Z |
| format | Article |
| id | doaj.art-282e779b87d84ce1807fdef61e2b22d6 |
| institution | Directory Open Access Journal |
| issn | 2039-7275 2039-7283 |
| language | English |
| last_indexed | 2024-04-11T18:13:55Z |
| publishDate | 2018-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Clinics and Practice |
| spelling | doaj.art-282e779b87d84ce1807fdef61e2b22d62022-12-22T04:09:59ZengMDPI AGClinics and Practice2039-72752039-72832018-06-018210.4081/cp.2018.1057Anesthetic management of a neonate with congenital diaphragmatic hernia under high-frequency oscillatory ventilationIpek S. Edipoglu0Fatma Celik1Tutku Ozdogan2Serdar Comert3B. Haluk Guvenc4Department of Anesthesiology, Health Sciences University, Suleymaniye Women Maternity and Child Diseases Training and Research Hospital, IstanbulDepartment of Anesthesiology, Health Sciences University, Suleymaniye Women Maternity and Child Diseases Training and Research Hospital, IstanbulDepartment of NICU, Health Sciences University, Suleymaniye Women Maternity and Child Diseases Training and Research Hospital, IstanbulDepartment of NICU, Health Sciences University, Suleymaniye Women Maternity and Child Diseases Training and Research Hospital, IstanbulDepartment of Pediatric Surgery, Health Sciences University, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, IstanbulPerioperative 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.https://www.clinicsandpractice.org/index.php/cp/article/view/1057Congenitaldiaphragmaticherniahigh-frequencyoscillatoryventilation. |
| spellingShingle | Ipek S. Edipoglu Fatma Celik Tutku Ozdogan Serdar Comert B. Haluk Guvenc Anesthetic management of a neonate with congenital diaphragmatic hernia under high-frequency oscillatory ventilation Clinics and Practice Congenital diaphragmatic hernia high-frequency oscillatory ventilation. |
| title | Anesthetic management of a neonate with congenital diaphragmatic hernia under high-frequency oscillatory ventilation |
| title_full | Anesthetic management of a neonate with congenital diaphragmatic hernia under high-frequency oscillatory ventilation |
| title_fullStr | Anesthetic management of a neonate with congenital diaphragmatic hernia under high-frequency oscillatory ventilation |
| title_full_unstemmed | Anesthetic management of a neonate with congenital diaphragmatic hernia under high-frequency oscillatory ventilation |
| title_short | Anesthetic management of a neonate with congenital diaphragmatic hernia under high-frequency oscillatory ventilation |
| title_sort | anesthetic management of a neonate with congenital diaphragmatic hernia under high frequency oscillatory ventilation |
| topic | Congenital diaphragmatic hernia high-frequency oscillatory ventilation. |
| url | https://www.clinicsandpractice.org/index.php/cp/article/view/1057 |
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