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

다국어 초록 (Multilingual Abstract)

Background: The purpose of this study was to assess the safety issues concerning anesthetic management of videoassisted 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.

참고문헌 (Reference)

1 Cano I, "Video-assisted thoracoscopic lobectomy in infants" 29 : 997-1000, 2006

2 Gentili A, "Thoracoscopy in children: anaesthesiological implications and case reports" 73 : 161-171, 2007

3 Ko R, "The use of air in the inspired gas mixture during two-lung ventilation delays lung collapse during one-lung ventilation" 108 : 1092-1096, 2009

4 Mukhtar AM, "The therapeutic potential of intraoperative hypercapnia during videoassisted thoracoscopy in pediatric patients" 106 : 84-88, 2008

5 Choudhry DK, "Single-lung ventilation in pediatric anesthesia" 23 : 693-708, 2005

6 Kim JT, "Simple multiport adaptor for selective lung ventilation in pediatric patients" 105-892, 2007

7 Haynes SR, "Review article: anaesthesia for thoracic surgery in children" 10 : 237-251, 2000

8 Rothenberg SS, "First decade's experience with thoracoscopic lobectomy in infants and children" 43 : 40-44, 2008

9 Albanese CT, "Experience with 144 consecutive pediatric thoracoscopic lobectomies" 17 : 339-341, 2007

10 McHoney M, "Effect of patient weight and anesthetic technique on CO2 excretion during thoracoscopy in children assessed by end-tidal CO2" 18 : 147-151, 2008

11 McHoney M, "Carbon dioxide elimination during laparoscopy in children is age dependent" 38 : 105-110, 2003

12 Borchardt RA, "Bronchial injury during lung isolation in a pediatric patient" 87 : 324-325, 1998

13 McGahren ED, "Anesthetic techniques for pediatric thoracoscopy" 60 : 927-930, 1995