Anesthetic management for the minimally invasive Nuss procedure in 21 patients with pectus excavatum
- 240 Downloads
The aim of this study was to assess the anesthetic management and postoperative analgesic effect of continuous epidural infusion for the minimally invasive Nuss procedure. A total of 21 operated cases were analyzed retrospectively. Thoracoscopy was used in all cases. General anesthesia with endotracheal intubation was induced and maintained with oxygen, air, sevoflurane, and fentanyl in all cases. Thoracic epidural anesthesia was performed after induction at the level between Th4 and 12. When the bar was placed via insertion under the sternum, six patients exhibited sinus tachycardia and one showed premature atrial contraction for 2–4 beats before recovering spontaneously within 1 min. Operations were uneventful. The mean operating time was 115 min and anesthetic time was 193 min. In X-ray findings, residual pneumothorax and pleural effusion were found in seven (33.3%) and eight (38.0%) patients, respectively. In all cases, these symptoms were resolved spontaneously within 5 days. Epidural fentanyl (0.3 µg·kg−1·h−1) in 0.125% bupivacaine (0.15 ml·kg−1·h−1) or 0.2% ropivacaine (0.15 ml·kg−1·h−1) were used for 3 days to relieve postoperative pain. Postoperatively, 12 (57.1%) patients required no additional analgesics, and 4 (19.0%) patients required a single dose of dicrofenac sodium or pentazocine. Although the Nuss procedure is minimally invasive, we should pay attention to the possibility of many intra- and postoperative complications. Continuous epidural infusion of fentanyl with local anesthetics provides effective postoperative pain relief and prevents complications such as bar displacement after the Nuss procedure.
Key wordsAnesthetic management Pectus excavatum Nuss procedure
Unable to display preview. Download preview PDF.
- 4.Shamberger, RC 1996Congenital chest wall deformitiesCurr Prob Surg23471542Google Scholar
- 5.Wakeno, M, Miyamoto, E, Nakao, S, Masuko, S, Shingu, K 2002Anesthetic management for the correction of pectus excavatum under video-assistance in children (in Japanese with English abstract). Nihon Rinshou MasuigakushiJ Jpn Soc Clin Anesth224852Google Scholar
- 7.Kariya, N, Inoue, Y, Minami, W, Ikeda, Y, Nishi, S, Nishikawa, K, Asada, A 2005Lumbar epidural morphine for postoperative analgesia in children undergoing Nuss procedure (in Japanese with English abstract)Masui Jpn J Anesthesiol54496499Google Scholar
- 8.Tsuda, N, Tanaka, H 2004Experience of parent-assisted patient controlled analgesia for postoperative pain management in children undergoing Nuss procedure (in Japanese with English abstract)Rinshoumasui (Clin Anesth)2813211323Google Scholar