The loss of oesophageal length or obliteration of oesophageal lumen due to stricture acquired by accidental caustic ingestion is more common in children that may require major operative reconstruction. A number of procedures have been developed for anatomic replacement of oesophagus of which thoracoscopic assisted gastric transposition has shown the best outcome in children. This demands an extensive pre-operative evaluation, preparation and anaesthetic management since this is challenging and prolonged procedure done under one lung ventilation (OLV). Though it is a minimally invasive procedure, providing OLV and management of complications associated with it are the anaesthetic challenges among these children. We report anaesthetic management of an 8-year-old boy with oesophageal stricture following corrosive injury posted for thoracoscopic assisted gastric transposition.
In the practice of paediatric anaesthesia, intubation of trachea without using neuromuscular blocking agents is becoming commoner more so in conditions in which muscle relaxants are not preferred. Different combinations of drugs including opioids, intravenous agents and inhalational agents are being used for facilitating endotracheal intubation when muscle relaxants are not used. In this study we compared intubating conditions in paediatric patients after sevoflurane induction and propofol in two different doses. Materials and Methods: 80 children of 2 to 12 years age undergoing elective surgeries were divided into two groups P2 and P3 of 40 each. After sevoflurane induction and fentanyl 2mcg/kg I.V. group P2 received propofol 2mg/kg and group P3 received propofol 3mg/kg I.V. The two groups were compared with respect to intubating conditions and haemodynamic parameters. Results: Clinically acceptable intubating conditions were seen in all patients in both groups. Excellent intubating conditions were more in group P3 (87.5%) than group P2 (80%). Haemodynamic parameters showed no significant difference between the two groups.
Conclusion:In paediatric patients, endotracheal intubation can be comfortably performed without muscle relaxants by using propofol and fentanyl with sevoflurane induction with no respiratory or haemodynamic adverse events. Propofol in a dose of 3mg/kg gives better intubating conditions than 2mg/kg without adverse haemodynamic effects, although 2mg/kg propofol also gives acceptable intubating conditions.
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