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

Abstract

Introduction: Congenital diaphragmatic hernias (CDH) are complex developmental anomaly. Itresults from anomalous closure of pericardio-peritoneal canal. Consequently, abdominal organs
extrude into the thoracic cavity, impairing the growth of the ipsilateral lung. Surgical correctionis 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 theanaesthetic management of CDH in patients who underwent surgical closure of the diaphragmaticdefect in a tertiary care centre of Nepal.
Method: This is a retrospective study carried over a period of one year. We reviewed the medicalrecords 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 underwentsurgical 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 commoncomplication during the perioperative period was hypoxia, bradycardia and pneumothorax. Thesurvival rate was 61.53%.
Conclusion: The anaesthetic management of CDH is still a difficult and challenging foranaesthesiologist. Bradycardia, hypoxia, pneumothorax, septicemia and DIC are the majorcauses of perioperative morbidity and mortality. Preoperative optimization and gentle ventilationstrategy makes significant impact on survival in child.
Key words: Congenital diaphragmatic hernia, hypoxia, pulmonary hypertension.