Congenital Diaphragmatic Hernia (CDH)

Congenital Diaphragmatic Hernia (CDH)

  • The clinical presentation of these patients is highly variable. For example, some require cardiopulmonary support with extracorporeal membrane oxygenation (ECMO) while others breathe spontaneously without any respiratory support. Before surgical repair, the "average" CDH patient undergoes several days of supportive care usually with mechanical ventilatory support (conventional or oscillator) in the Intensive Care Nursery to stabilize the transitional circulation.
  • In some cases, the surgeon opts for an open, transabdominal approach to remove the abdominal contents from the thoracic cavity and then repair the diaphragmatic defect either primarily or with an artificial patch. In other cases, the surgeon opts for a minimally invasive approach, where the impact of insufflation of carbon dioxide and, in many cases, a longer operative course must be considered.
  • With either surgical technique, anesthetic management centers on minimizing pulmonary vascular resistance (e.g. avoiding acidosis, hypoxia, hypothermia), but avoiding barotrauma.
  • Neonates with CDH are at risk for persistent fetal circulation; pre and post ductal oxygen saturations should be monitored.
  • In most cases, the anesthetic agents primarily include narcotic (usually fentanyl) and muscle relaxant (pancuronium/rocuronium). In particular, surgery performed in the Intensive Care Unit usually eliminates access to inhaled agents.
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This information is meant to serve as an educational resource. Clinicians should use their own professional judgment in the care of any individual patient as the guidance contained in this document may not be appropriate for all patients or all situations.