Challenges in Anaesthetic management of a child for thoracoscopic assisted oesophageal replacement

Abstract

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.

An Update on One-Lung Ventilation in Children

“…2–5 More recently, continued refinements in minimally invasive surgical techniques have popularized video-assisted thoracoscopic surgery (VATS) in children which has led to an increased need for lung isolation even in very young patients. 6–11…”

“…[2][3][4][5] More recently, continued refinements in minimally invasive surgical techniques have popularized video-assisted thoracoscopic surgery (VATS) in children which has led to an increased need for lung isolation even in very young patients. [6][7][8][9][10][11] Anatomical lung isolation in children may also be necessary to avoid cross-contamination from one lung to the other in cases of severe pulmonary hemorrhage or empyema. 12,13 Similarly, patients with pulmonary alveolar proteinosis require lung isolation for sequential whole lung lavages to clear the accumulation of lipoproteinaceous material within the alveoli.…”