QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe

Birth history and patient size are important preoperative considerations for esophageal atresia repair.

Physiologic status from ventilation and cardiac standpoints is particularly important in preoperative assessment.

Preoperative visualization of the child's airway allows better decision-making and potentially less time under anesthesia.

Akinesis (keeping children still) can be very challenging in small children, especially when intraoperative neuromonitoring is involved.

Intraoperative neuromonitoring precludes the use of neuromuscular blocking drugs like rocuronium and vecuronium.

Patients with compliance abnormalities often require higher peak inspiratory or mean airway pressures, resulting in the need for very high insufflation pressures.

Lung isolation utility is restricted by patient size and airway anatomy and requires expertise and specialized equipment.

Three dimensions are important for lung isolation: tracheal diameter (particularly AP diameter), bronchial diameters, and the length of the right main stem bronchus between carina and right upper lobe takeoff.

Regular endotracheal tube is the most common device for lung isolation in neonates because it is relatively straightforward to mainstem into the left bronchus, which has a good landing zone for the balloon.

Bronchial blockers or Fogarty catheters require enough space between the carina and right upper lobe takeoff for balloon placement.

In kids with a pig bronchus, bronchial blocker placement becomes very difficult and may require selective lobar blockade.

Bronchial blockers can be helpful in kids with abnormal parenchyma when higher ventilatory pressures are needed but higher insufflation pressures should be avoided.

Unrepaired single ventricle patients are sensitive to changes in ventilation because they can have swings in circulation direction based on pulmonary vascular resistance.

Insufflation causes changes in preload, and patients with passive pulmonary circulations are particularly sensitive to this insufflation.