Anesthesia for Pediatric Thoracic Surgery

Abstract

Pediatric patients present in varying stages of development, from the premature neonate to full-grown teenager. Appreciation of the unique physiologic states associated with the different stages of development will direct anesthetic management. Preoperative evaluation of the small child should include the neonatal history as this may indicate comorbid pulmonary and cardiac disease and linked syndromes which must be investigated. Lung isolation is not always necessary in pediatric thoracic surgery. Appropriate lung isolation techniques will depend on the age and size of the patient as there is no single technique that is suitable for all pediatric patients. Physiologic manifestation of one-lung ventilation may be more pronounced in children than in adults. The compliant rib cage, compressible lung parenchyma, reduced FRC under anesthesia, and higher oxygen consumption in the child contribute to aggravate hypoxemia during lung isolation. Adult thoracic surgery is often related to tumor excision whereas pediatric thoracic disease encompasses a greater variety of pathology. Each specific disease state has its own particular anesthetic considerations and management strategy. Pain management in the pediatric population has evolved to include a greater use of regional and neuraxial techniques, even in the smallest of infants. Postoperative disposition will depend on the type and length of surgery, extent of resection or manipulation, and nature of the underlying condition. Many pediatric patients will require postoperative ventilation or close cardiorespiratory monitoring following the procedure.