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LETTER TO THE EDITOR

Ventilation Management During Neonatal Thoracic Surgery

Réanimation Pédiatrique (PICU), jean-christophe.bouchut{at}chu-lyon.fr (Bouchut) Réanimation Néonatale (NICU), Hôpital Edouard Herriot, Lyon, France (Claris)

To the Editor:

In their recent case report, Schmidt et al. (1) described using single-lung ventilation in a 3000 g ex-premature, newborn infant who required surgery because of congenital emphysema of the upper-pulmonary lobe. As they pointed out, one should be cautious when transposing techniques for adult patients into neonatal practice. However, the technique they described raised some critical points.

First, one-lung ventilation is not always required during open thoracic surgery in neonates (2). The positive-pressure ventilation in this case led to rapid expansion of the emphysematous lobe, compromising ventilation and hemodynamic status. However, this infant required periods of mechanical ventilation before surgery because of pulmonary infection, without such complications. We agree that the ventilator on the anesthesia machine probably increased the risk of complications.

Second, one-lung ventilation of a 3000-g infant with the limited ventilator built into the anesthesia machine is challenging. The blood gas values and the fact that manual ventilation was required demonstrate the limitations of these ventilators. During the entire period of surgery, the high peak airway pressure and sheer stress forces during the cyclical closing and reopening of the terminal lung units exposed the neonate to lung injury.

Our practice is to use a neonatal ventilator during neonatal surgery. This limits the risk of mechanical complications and ventilator-induced lung injury, and avoids the need to provide manual ventilation during surgery (3). Because our ventilation circuitry does not permit using inhaled anesthetics during anesthesia, we administer total IV anesthesia or regional anesthesia. The intraoperative use of high-frequency oscillatory ventilation and two-lung ventilation does not alter surgical conditions, which are considered satisfactory by the surgeons (3).

Third, a high inside-diameter tracheal tube, age, and weight-appropriate, may cause laryngotracheal complications (4).

We agree that some techniques developed for adults should benefit neonates. However, we would like to emphasize the usefulness of techniques developed and validated in the neonatal intensive care unit, which could also benefit the neonate during anesthesia.

REFERENCES

1. Schmidt C, Rellensmann G, Van Aken H, et al. Single-lung ventilation for pulmonary lobe resection in a newborn. Anesth Analg 2005;101:362–4.[Abstract/Free Full Text]
2. Tobias JD. Anaesthesia for neonatal thoracic surgery. Best Pract Res Clin Anaesthesiol 2004;18:303–20.[Medline]
3. Bouchut JC, Godard J, Claris O. High-frequency oscillatory ventilation. Anesthesiology 2004;100:1007–12.[ISI][Medline]
4. Turner BS, Loan LA. Tracheobronchial trauma associated with airway management in neonates. AACN Clin Issues 2000;11:283–99.[Medline]

This article has been cited by other articles:

				D. Enk, G. Rellensmann, T. Brussel, H. Van Aken, M. Semik, and C. Schmidt Ventilation Management During Neonatal Thoracic Surgery Anesth. Analg., January 1, 2007; 104(1): 218 - 219. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bouchut, J.-C. Articles by Claris, O. Search for Related Content PubMed PubMed Citation Articles by Bouchut, J.-C. Articles by Claris, O.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999