Congenital Diaphragmatic Hernia Repair Under Thoracic Segmental Spinal Anesthesia

Abstract

INTRODUCTION: Congenital diaphragmatic hernia (CDH) is a rare condition where an incomplete closure of developing diaphragm results in herniation of the abdominal viscera into thoracic cavity. The thoracic crowding and increased pressure detrimentally affect the developing cardiopulmonary system. Thoracic segmental spinal anesthesia offers many advantages in such patients at high risk for morbidity and mortality under general anesthesia.
CASE HISTORY: Presenting a case of 4 months old male, 7.3 kg weight child presented with chief complaint of vomiting for 4 days immediately after feeding associated with respiratory distress. Preoperative work up and Chest x-ray was done suggested left congenital diaphragmatic hernia. Diaphragmatic hernia repair was planned under thoracic segmental spinal anesthesia. Patient was given premedication of Inj. Ketamine and Inj. Dexmedetomidine. Under aseptic precaution, thoracic segmental spinal anesthesia with isobaric Inj. Levobupivacaine 0.5% 0.3 ml with additive inj. Dexmedetomidine was given. Intraoperatively IV fluid Injection Inj. Ringer lactate was given. O2 was given via facemask & Patient was hemodynamically stable intraoperatively and postoperatively.
CONCLUSION: Congenital diaphragmatic hernia remains one of the most challenging conditions for pediatric anesthetists, surgeons and intensivists to treat successfully. Spinal anesthesia has advantage over general anesthesia as spinal anesthesia has little effect on respiration and cardiac complication, which avoid airway instrumentation, avoids postoperative ventilation and provide post-operative better analgesia, earlier recovery of bowel function, and decreased complication which result in a shorten length of in hospital stay.