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Right sided congenital diaphragmatic hernia: A rare neonatal emergency.

Parate LH, Geetha CR, Vig S - Saudi J Anaesth (2015 Apr-Jun)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, M.S. Ramaiah Medical Collage, Bengaluru, Karnataka, India.

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Presence of liver herniation is a predictive of poor outcome... It results in caval compression, reduced preload and impaired cardiac output... Ventilation was instituted by keeping peak inspiratory pressure (PIP) of 20 cm H2O, FiO2 of 0.6 and respiratory rate of 60/min... His ABG revealed pH-7.25, PCO2 -44 mmHg, PO2 -88 mmHg HCO3 -18 mEq/L and lactates-1.5 ummol/L... His preductual and postductal SpO2 differed by 5%... Baseline parameters of heart rate 144/min and BP-66/40 mmHg were noted... His preductal SpO2 was 95% and posductal saturation was 90%... Pressure controlled ventilation was started with PIP of 20 cm H2O, respiratory rate of 50/min with FiO2 of 0.7... A right subcostal incision was made... Liver and bowel loops were reduced [Figure 2]... It consists of limiting PIP <25 cm H2O, permissive hypercapnia (PaCO2 between 45 and 60 mmHg)... Many centers lack advanced neonatal care facilities affecting the prognosis... However, still conventional technique have shown good outcome.

No MeSH data available.


Related in: MedlinePlus

Right congenital diaphragmatic hernia with reduced contents (liver and intestine)
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Figure 2: Right congenital diaphragmatic hernia with reduced contents (liver and intestine)

Mentions: Inside operation theater routine monitors (electrocardiogram, noninvasive blood pressure, SpO2, EtCO2, temperature) were attached. Neonatal resuscitation trolley was kept ready. Baseline parameters of heart rate 144/min and BP-66/40 mmHg were noted. His preductal SpO2 was 95% and posductal saturation was 90%. Continuous nasogastric suctioning was done. Intravenous (IV) fentanyl 5 ug and IV atracurium was given. Pressure controlled ventilation was started with PIP of 20 cm H2O, respiratory rate of 50/min with FiO2 of 0.7. Anesthesia was maintained with oxygen, air and sevoflurane. The anaesthetic goal was to avoid hypoxia, hypotension and hypothermia, which increases pulmonary vascular resistance and worsens the right to left shunt. A right subcostal incision was made. Liver and bowel loops were reduced [Figure 2]. The defect in right hemidiaphragm was closed. Child remained stable throughout the surgery. Duration of surgery was 2 h. Intraoperative blood and fluid loss were replaced with Isolyte P. Child was electively ventilated postoperatively. IV morphine infusion was started for sedation. Muscle relaxants were avoided, and spontaneous respiration was encouraged. Child was extubated on POD 5, but could not tolerate extubation and was reintubated on the same day. On POD 8 again trial for extubation was given which he tolerated well.


Right sided congenital diaphragmatic hernia: A rare neonatal emergency.

Parate LH, Geetha CR, Vig S - Saudi J Anaesth (2015 Apr-Jun)

Right congenital diaphragmatic hernia with reduced contents (liver and intestine)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374241&req=5

Figure 2: Right congenital diaphragmatic hernia with reduced contents (liver and intestine)
Mentions: Inside operation theater routine monitors (electrocardiogram, noninvasive blood pressure, SpO2, EtCO2, temperature) were attached. Neonatal resuscitation trolley was kept ready. Baseline parameters of heart rate 144/min and BP-66/40 mmHg were noted. His preductal SpO2 was 95% and posductal saturation was 90%. Continuous nasogastric suctioning was done. Intravenous (IV) fentanyl 5 ug and IV atracurium was given. Pressure controlled ventilation was started with PIP of 20 cm H2O, respiratory rate of 50/min with FiO2 of 0.7. Anesthesia was maintained with oxygen, air and sevoflurane. The anaesthetic goal was to avoid hypoxia, hypotension and hypothermia, which increases pulmonary vascular resistance and worsens the right to left shunt. A right subcostal incision was made. Liver and bowel loops were reduced [Figure 2]. The defect in right hemidiaphragm was closed. Child remained stable throughout the surgery. Duration of surgery was 2 h. Intraoperative blood and fluid loss were replaced with Isolyte P. Child was electively ventilated postoperatively. IV morphine infusion was started for sedation. Muscle relaxants were avoided, and spontaneous respiration was encouraged. Child was extubated on POD 5, but could not tolerate extubation and was reintubated on the same day. On POD 8 again trial for extubation was given which he tolerated well.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, M.S. Ramaiah Medical Collage, Bengaluru, Karnataka, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Presence of liver herniation is a predictive of poor outcome... It results in caval compression, reduced preload and impaired cardiac output... Ventilation was instituted by keeping peak inspiratory pressure (PIP) of 20 cm H2O, FiO2 of 0.6 and respiratory rate of 60/min... His ABG revealed pH-7.25, PCO2 -44 mmHg, PO2 -88 mmHg HCO3 -18 mEq/L and lactates-1.5 ummol/L... His preductual and postductal SpO2 differed by 5%... Baseline parameters of heart rate 144/min and BP-66/40 mmHg were noted... His preductal SpO2 was 95% and posductal saturation was 90%... Pressure controlled ventilation was started with PIP of 20 cm H2O, respiratory rate of 50/min with FiO2 of 0.7... A right subcostal incision was made... Liver and bowel loops were reduced [Figure 2]... It consists of limiting PIP <25 cm H2O, permissive hypercapnia (PaCO2 between 45 and 60 mmHg)... Many centers lack advanced neonatal care facilities affecting the prognosis... However, still conventional technique have shown good outcome.

No MeSH data available.


Related in: MedlinePlus