Management of Congenital Diaphragmatic Hernia with Epidural and General Anaesthesia

Abstract

Surgical repair of Congenital Diaphragmatic Hernia (CDH) is one of the major neonatal emergencies that pose many challenges to the treating neonatologist, intensivist, pediatric anesthesiologist and the surgeon. Mostly these babies are premature having physiological immaturity of various organ systems and in association they may be having lung pathologies or other major congenital defects. Smooth induction/maintenance, adequate intra/post-operative analgesia and uneventful post-operative recovery are the major objectives to be achieved with the anesthetic plan. The use of Regional Anesthesia (RA) has found to be very safe and effective when combined with General Anesthesia (GA). We report a case of two days old baby for surgical repair of CDH that was managed successfully with GA along with epidural analgesia .The baby was induced and intubated under O2 + sevoflurane anesthesia and maintained with muscle relaxant atracurium. Epidural catheter was passed up to T6 through caudal route to facilitate intra and post-operative analgesia with ropivacaine. There was excellent hemodynamic stability, satisfactory perioperative pain relief and uneventful recovery.