piperidines and Barotrauma

We describe a continuous flow mode of ventilation for repair of type I esophageal atresia in an infant. This type of atresia is defined by distal stenosis of the esophagus with a proximal blind pouch and no connection to the tracheobronchial tree. In traditional repair procedures the surgical approach is by thoracotomy, but newer videoassisted thoracoscopic techniques have introduced novel challenges to ventilatory mechanics in these low-weight infants. The literature contains little discussion of the anesthetic management or respiratory mechanics of these patients. Trying to maintain adequate tidal volume and oxygenation while thoracoscopic maneuvers take place increases the risk of barotrauma. Single-lung ventilation with a continuous flow respirator was effective in the case we report.

Topics: Abnormalities, Multiple; Anesthesia, Intravenous; Anesthetics, Intravenous; Barotrauma; Carbon Dioxide; Esophageal Atresia; Humans; Hydrogen-Ion Concentration; Infant; Intraoperative Care; Intraoperative Complications; Lung Compliance; Male; Oxygen; Piperidines; Pressure; Remifentanil; Respiration, Artificial; Thoracic Surgery, Video-Assisted; Tidal Volume