Anesthesia for Pediatric Thoracic Surgery

  • Robert Schwartz
  • Cengiz Karsli


Pediatric patients present in varying stages of development, from the premature neonate to full-grown teenager. Appreciation of the unique physiologic states associated with the different stages of development will direct anesthetic management. Preoperative evaluation of the small child should include the neonatal history as this may indicate comorbid pulmonary and cardiac disease and linked syndromes which must be investigated. Lung isolation is not always necessary in pediatric thoracic surgery. Appropriate lung isolation techniques will depend on the age and size of the patient as there is no single technique that is suitable for all pediatric patients. Physiologic manifestation of one-lung ventilation may be more pronounced in children than in adults. The compliant rib cage, compressible lung parenchyma, reduced FRC under anesthesia and higher oxygen consumption in the child contribute to aggravate hypoxemia during lung isolation. Adult thoracic surgery is often related to tumor excision whereas pediatric thoracic disease encompasses a greater variety of pathology. Each specific disease state has its own particular anesthetic considerations and management ­strategy. Pain management in the pediatric population has evolved to include a greater use of regional and neuraxial techniques, even in the smallest of infants. Postoperative disposition will depend on the type and length of surgery, extent of resection or manipulation, and nature of the underlying condition. Many pediatric patients will require postoperative ventilation or close cardiorespiratory monitoring following the procedure.


Patent Ductus Arteriosus Congenital Diaphragmatic Hernia Superior Vena Cava Tracheal Tube Mediastinal Mass 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Sweet DG, Halliday HL. The use of surfactants in 2009. Arch Dis Child Educ Pract Ed. 2009;94(3):78–83.PubMedGoogle Scholar
  2. 2.
    Sekar KC, Corff KE. To tube or not to tube babies with respiratory distress syndrome. J Perinatol. 2009;29 Suppl 2:S68–72.PubMedGoogle Scholar
  3. 3.
    Verder H, Bohlin K, Kamper J, Lindwall R, Jonsson B. Nasal CPAP and surfactant for treatment of respiratory distress syndrome and prevention of bronchopulmonary dysplasia. Acta Paediatr. 2009;98(9):1400–8. Epub 2009 Jul 1.Google Scholar
  4. 4.
    Lista G, et al. Nasal continuous positive airway pressure (CPAP) versus bi-level nasal CPAP in preterm babies with respiratory distress syndrome: a randomised control trial. Arch Dis Child Fetal Neonatal Ed. 2010;95(2):F85–9.Google Scholar
  5. 5.
    Soll R, Ozek E. Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2009;(1):CD000141.Google Scholar
  6. 6.
    Cogo PE, et al. Dosing of porcine surfactant: effect on kinetics and gas exchange in respiratory distress syndrome. Pediatrics. 2009;124(5):e950–7. Epub 2009 Oct 12.Google Scholar
  7. 7.
    Suresh GK, Soll RF. Overview of surfactant replacement trials. J Perinatol. 2005;25 Suppl 2:S40–4.PubMedGoogle Scholar
  8. 8.
    Blaise G et al. Pulmonary arterial hypertension pathophysiology and anesthetic approach. Anesthesiology. 2003;99:1415–32.PubMedGoogle Scholar
  9. 9.
    Hawkins A, Tulloh R. Treatment of pediatric pulmonary hypertension. Vasc Health Risk Manag. 2009;5(2):509–24. Epub 2009 Jun 7.Google Scholar
  10. 10.
    Konduri GG, Kim UO. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatr Clin N Am. 2009;56(3):579–600, Table of Contents.Google Scholar
  11. 11.
    Knoderer CA, Morris JL, Ebenroth ES. Sildenafil for the treatment of pulmonary hypertension in pediatric patients. Pediatr Cardiol. 2009;30(7):871–82. Epub 2009 Aug 25.Google Scholar
  12. 12.
    Krishnan U, Krishnan S, Gewitz M. Treatment of pulmonary hypertension in children with chronic lung disease with newer oral therapies. Pediatr Cardiol. 2008;29(6):1082–6. Epub 2008 Jul 2.Google Scholar
  13. 13.
    MacKnight B, Martinez EA, Simon BA. Anesthetic management of patients with pulmonary hypertension. Semin Cardiothorac Vasc Anesth. 2008;12(2):91–6.PubMedGoogle Scholar
  14. 14.
    Galante D. Intraoperative management of pulmonary arterial hypertension in infants and children. Curr Opin Anaesthesiol. 2009;22(3):378–82.PubMedGoogle Scholar
  15. 15.
    Rosenzweig EB, Barst RJ. Pulmonary arterial hypertension in children: a medical update. Indian J Pediatr. 2009;76(1):77–81. Epub 2009 Apr 18.Google Scholar
  16. 16.
    Friesen RH, Williams GD. Anesthetic management of children with pulmonary arterial hypertension. Paediatr Anaesth. 2008;18(3):208–16.PubMedGoogle Scholar
  17. 17.
    Taylor K, Holtby H. Emergency interventional lung assist for pulmonary hypertension. Anesth Analg. 2009;109(2):382–5.PubMedGoogle Scholar
  18. 18.
    Ayers J, Graves SA. Perioperative management of total parenteral nutrition, glucose containing solutions, and intraoperative glucose monitoring in paediatric patients: a survey of clinical practice. Paediatr Anaesth. 2001;11(1):41–4.PubMedGoogle Scholar
  19. 19.
    Fösel TH, Uth M, Wilhelm W, Grüness V. Comparison of two solutions with different glucose concentrations for infusion therapy during laparotomies in infants. Infusionsther Transfusionsmed. 1996;23(2):80–4.PubMedGoogle Scholar
  20. 20.
    Gauda EB, McLemore GL, Tolosa J, Marston-Nelson J, Kwak D. Maturation of peripheral arterial chemoreceptors in relation to neonatal apnoea. Semin Neonatol. 2004;9(3):181–94.PubMedGoogle Scholar
  21. 21.
    Choudhry DK. Single-lung ventilation in pediatric anesthesia. Anesthesiol Clin N Am. 2005;23:693–708.Google Scholar
  22. 22.
    Rowe R, Andropoulos D, Heard M, et al. Anesthestic management of pediatric patients undergoing thoracoscopy. J Cardiothorac Vasc Anesth. 1994;8:563–6.PubMedGoogle Scholar
  23. 23.
    Kubota H, Kubota Y, Toyoda Y, et al. Selective blind endobronchial intubation in children and adults. Anesthesiology. 1987;67:587–9.PubMedGoogle Scholar
  24. 24.
    Rehman M, Sherlekar S, Schwartz R, et al. One lung ­anesthesia for video assisted thoracoscopic lung biopsy in a paediatric patient. Paediatr Anaesth. 1999;9:85–7.PubMedGoogle Scholar
  25. 25.
    Hammer GB, Harrison TK, Vricella LA, Black MD, Krane EJ. Single lung ventilation in children using a new paediatric bronchial blocker. Paediatr Anaesth. 2002;12(1):69–72.PubMedGoogle Scholar
  26. 26.
    Takahashi M, Yamada M, Honda I, Kato M, Yamamuro M, Hashimoto Y. Selective lobar – bronchial blocking for pediatric video-assisted thoracic surgery. Anesthesiology. 2001;94(1):170–2.PubMedGoogle Scholar
  27. 27.
    Chengod S, Chandrasekharan AP, Manoj P. Selective left bronchial intubation and left-lung isolation in infants and toddlers: analysis of a new technique. J Cardiothorac Vasc Anesth. 2005;19(5):636–41.PubMedGoogle Scholar
  28. 28.
    Gayes JM. Pro: one-lung ventilation is best accomplished with the Univent endotracheal tube. J Cardiothorac Vasc Anesth. 1993;7:103–7.PubMedGoogle Scholar
  29. 29.
    Kamaya H, Krishna PR. New endotracheal tube (univent tube) for selective blockade of one lung. Anesthesiology. 1985;63:342–3.PubMedGoogle Scholar
  30. 30.
    Hammer GB, Brodsky JB, Redpath JH, Cannon WB. The Univent tube for single-lung ventilation in paediatric patients. Paediatr Anaesth. 1998;8(1):55–7.PubMedGoogle Scholar
  31. 31.
    Arndt GA, DeLessio ST, Kranner PW, Orzepowski W, Ceranski B, Valtysson B. One-lung ventilation when intubation is difficult – presentation of a new endobronchial blocker. Acta Anaesthesiol Scand. 1999;43(3):356–8.PubMedGoogle Scholar
  32. 32.
    Yun ES, Saulys A, Popic PM, Arndt GA. Single-lung ventilation in a pediatric patient using a pediatric fibreoptically-directed wire-guided endobronchial blocker. Can J Anaesth. 2002;49(3):256–61.PubMedGoogle Scholar
  33. 33.
    Li PY, Gu HH, Liang WM. Sequential one-lung ventilation using one Arndt endobronchial blocker in a pediatric patient undergoing bilateral, video-assisted thoracoscopic surgery (VATS). J Clin Anesth. 2009;21(6):464.PubMedGoogle Scholar
  34. 34.
    Hammer GB, Fitzmaurice BG, Brodsky JB. Methods for single-lung ventilation in pediatric patients. Anesth Analg. 1999;89:1426–9.PubMedGoogle Scholar
  35. 35.
    Klein U, Karzai W, Bloos F, Wohlfarth M, Gottschall R, Fritz H, et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study. Anesthesiology. 1998;88(2):346–50.PubMedGoogle Scholar
  36. 36.
    Fitzmaurice BG, Brodsky JB. Airway rupture from double-lumen tubes. J Cardiothorac Vasc Anesth. 1999;13:322–9.PubMedGoogle Scholar
  37. 37.
    Tezel C, Okur E, Baysungur V. Iatrogenic tracheal rupture during intubation with a double-lumen tube. Thorac Cardiovasc Surg. 2010;58(1):54–6.PubMedGoogle Scholar
  38. 38.
    Nicolai T. Pediatric bronchoscopy. Pediatr Pulmonol. 2001;31(2): 150–64.PubMedGoogle Scholar
  39. 39.
    Slonim AD, Ognibene FP. Amnestic agents in pediatric bronchoscopy. Chest. 1999;116(6):1802–8.PubMedGoogle Scholar
  40. 40.
    Berkenbosch JW, Graff GR, Stark JM, Ner Z, Tobias JD. Use of a remifentanil-propofol mixture for pediatric flexible fiberoptic bronchoscopy sedation. Paediatr Anaesth. 2004;14(11):941–6.PubMedGoogle Scholar
  41. 41.
    Larsen R, Galloway D, Wadera S, Kjar D, Hardy D, Mirkes C, Wick L, Pohl JF. Safety of propofol sedation for pediatric outpatient procedures. Clin Pediatr (Phila). 2009;48(8):819–23. Epub 2009 May 29.Google Scholar
  42. 42.
    Tobias JD. Sedation and anesthesia for pediatric bronchoscopy. Curr Opin Pediatr. 1997;9(3):198–206.PubMedGoogle Scholar
  43. 43.
    Dilos BM. Anesthesia for pediatric airway endoscopy and upper gastrointestinal endoscopy. Int Anesthesiol Clin. 2009;47:55–62.PubMedGoogle Scholar
  44. 44.
    Seybold JL. The use of dexmedetomidine during laryngoscopy, bronchoscopy, and tracheal extubation following tracheal reconstruction. Pediatr Anesth. 2007;17:1212–4.Google Scholar
  45. 45.
    Niggemann B, Haack M, Machotta A. How to enter the pediatric airway for bronchoscopy. Pediatr Int. 2004;46(2):117–21.PubMedGoogle Scholar
  46. 46.
    Zestos MM, Bhattacharya D, Rajan S, Kemper S, Haupert M. Propofol decreases waste anesthetic gas exposure during pediatric bronchoscopy. Laryngoscope. 2004;114(2):212–5.PubMedGoogle Scholar
  47. 47.
    Nussbaum E, Zagnoev M. Pediatric fiberoptic bronchoscopy with a laryngeal mask airway. Chest. 2001;120(2):614–6.PubMedGoogle Scholar
  48. 48.
    Bandla HP, Smith DE, Kiernan MP. Laryngeal mask airway facilitated fibreoptic bronchoscopy in infants. Can J Anaesth. 1997;44(12):1242–7.PubMedGoogle Scholar
  49. 49.
    Naguib ML, Streetman DS, Clifton S, Nasr SZ. Use of laryngeal mask airway in flexible bronchoscopy in infants and children. Pediatr Pulmonol. 2005;39(1):56–63.PubMedGoogle Scholar
  50. 50.
    Somri M, Barna Teszler C, Tome R, Kugelman A, Vaida S, Gaitini L. Flexible fiberoptic bronchoscopy through the laryngeal mask airway in a small, premature neonate. Am J Otolaryngol. 2005;26(4):268–71.PubMedGoogle Scholar
  51. 51.
    Picard E, Schwartz S, Goldberg S, Glick T, Villa Y, Kerem E. A prospective study of fever and bacteremia after flexible fiberoptic bronchoscopy in children. Chest. 2000;117(2):573–7.PubMedGoogle Scholar
  52. 52.
    Picard E, Goldberg S, Virgilis D, Schwartz S, Raveh D, Kerem E. A single dose of dexamethasone to prevent postbronchoscopy fever in children: a randomized placebo-controlled trial. Chest. 2007;131(1):201–5.PubMedGoogle Scholar
  53. 53.
    Nussbaum E. Pediatric fiberoptic bronchoscopy: clinical experience with 2,836 bronchoscopies. Pediatr Crit Care Med. 2002;3(2):171–6.PubMedGoogle Scholar
  54. 54.
    Salva PS, Theroux C, Schwartz D. Safety of endobronchial biopsy in 170 children with chronic respiratory symptoms. Thorax. 2003;58(12):1058–60.PubMedGoogle Scholar
  55. 55.
    Shah R, Reddy AS, Dhende NP. Video assisted thoracic surgery in children. J Minim Access Surg. 2007;3(4):161–7.PubMedGoogle Scholar
  56. 56.
    Oak SN, Parelkar SV, Satishkumar KV, Pathak R, Ramesh BH, Sudhir S, et al. Review of video-assisted thoracoscopy in children. J Minim Access Surg. 2009;5(3):57–62.PubMedGoogle Scholar
  57. 57.
    de Campos JR, Andrade Filho LO, Werebe EC, Minamoto H, Quim AO, Filomeno LT, et al. Thoracoscopy in children and adolescents. Chest. 1997;111(2):494–7.PubMedGoogle Scholar
  58. 58.
    Tobias JD. Thoracic surgery in children. Curr Opin Anaesthesiol. 2001;14(1):77–85.PubMedGoogle Scholar
  59. 59.
    Sundararajan L, Parikh DH. Evolving experience with video-assisted thoracic surgery in congenital cystic lung lesions in a British pediatric center. J Pediatr Surg. 2007;42(7):1243–50.PubMedGoogle Scholar
  60. 60.
    Dutta S, Mihailovic A, Benson L, Kantor PF, Fitzgerald PG, Walton JM, Langer JC, Cameron BH. Thoracoscopic ligation versus coil occlusion for patent ductus arteriosus: a matched cohort study of outcomes and cost. Surg Endosc. 2008;22(7):1643–8. Epub 2007 Nov 20.Google Scholar
  61. 61.
    Byington CL, Spencer LY, Johnson TA, Pavia AT, Allen D, Mason EO, Kaplan S, Carroll KC, Daly JA, Christenson JC, Samore MH. An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infect Dis. 2002;34(4):434–40. Epub 2002 Jan 3.Google Scholar
  62. 62.
    Aziz A, Healey JM, Qureshi F, Kane TD, Kurland G, Green M, et al. Comparative analysis of chest tube thoracostomy and video-assisted thoracoscopic surgery in empyema and parapneumonic effusion associated with pneumonia in children. Surg Infect (Larchmt). 2008;9(3):317–23.Google Scholar
  63. 63.
    Chen CY, Chen JS, Huang LM, Lee PI, Lu CY, Lee YC, et al. Favorable outcome of parapneumonic empyema in children managed by primary video-assisted thoracoscopic debridement. J Formos Med Assoc. 2003;102(12):845–50.PubMedGoogle Scholar
  64. 64.
    Kang DW, Campos JR, Andrade Filho Lde O, Engel FC, Xavier AM, Macedo M, et al. Thoracoscopy in the treatment of pleural empyema in pediatric patients. J Bras Pneumol. 2008;34(4):205–11.PubMedGoogle Scholar
  65. 65.
    Chen JS, Huang KC, Chen YC, Hsu HH, Kuo SW, Huang PM, Lee JM, Lee YC. Pediatric empyema: outcome analysis of thoracoscopic management. J Thorac Cardiovasc Surg. 2009;137(5):1195–9. Epub 2009 Feb 7.Google Scholar
  66. 66.
    Cohen G, Hjortdal V, Ricci M, Jaffe A, Wallis C, Dinwiddie R, Elliott MJ, de Leval MR. Primary thoracoscopic treatment of empyema in children. J Thorac Cardiovasc Surg. 2003;125(1):79–83; discussion 83–4.Google Scholar
  67. 67.
    Gates RL, Caniano DA, Hayes JR, Arca MJ. Does VATS provide optimal treatment of empyema in children? A systematic review. J Pediatr Surg. 2004;39(3):381–6.PubMedGoogle Scholar
  68. 68.
    Avansino JR, Goldman B, Sawin RS, Flum DR. Primary operative versus nonoperative therapy for pediatric empyema: a meta-analysis. Pediatrics. 2005;115(6):1652–9.PubMedGoogle Scholar
  69. 69.
    St Peter SD, Tsao K, Spilde TL, Keckler SJ, Harrison C, Jackson MA, et al. Thoracoscopic decortication vs. tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg. 2009;44(1):106–11.PubMedGoogle Scholar
  70. 70.
    Ho AC, Chen CY, Yang MW, Liu HP. Use of the Arndt wire-guided endobronchial blocker to facilitate one-lung ventilation for pediatric empyema during video-assisted thoracoscopy. Chang Gung Med J. 2005;28(2):104–10.PubMedGoogle Scholar
  71. 71.
    Tobias JD. Variations on one-lung ventilation. J Clin Anesth. 2001;13(1):35–9.PubMedGoogle Scholar
  72. 72.
    Ho AC, Chung HS, Lu PP, Hong CL, Yang MW, Liu HP. Facilitation of alternative one-lung and two-lung ventilation by use of an endotracheal tube exchanger for pediatric empyema during video-assisted thoracoscopy. Surg Endosc. 2004;18(12):1752–6. Epub 2004 Oct 13.Google Scholar
  73. 73.
    Nezafati MH, Soltani G, Vedadian A. Video-assisted ductal closure with new modifications: minimally invasive, maximally effective, 1,300 cases. Ann Thorac Surg. 2007;84(4):1343–8.PubMedGoogle Scholar
  74. 74.
    Mavroudis C. Forty-six years of patient ductus arteriosus division at Children’s Memorial Hospital of Chicago. Standards for comparison. Ann Surg. 1994;220(3):402–10.PubMedGoogle Scholar
  75. 75.
    Wang JK, Hwang JJ, Chiang FT, Wu MH, Lin MT, Lee WL, Lue HC. A strategic approach to transcatheter closure of patent ductus: gianturco coils for small-to-moderate ductus and Amplatzer duct occluder for large ductus. Int J Cardiol. 2006;106(1):10–5. Epub 2005 Sep 15.Google Scholar
  76. 76.
    Daher AH. Infective endocarditis in neonates. Clin Pediatr (Phila). 1995;34(4):198–206.Google Scholar
  77. 77.
    Vanamo K. Video-assisted thoracoscopic versus open surgery for persistent ductus arteriosus. J Pediatr Surg. 2006;41(7):1226–9.PubMedGoogle Scholar
  78. 78.
    Villa E. Video-assisted thoracoscopic clipping of patent ductus arteriosus: close to the gold standard and minimally invasive competitor of percutaneous techniques. J Cardiovasc Med (Hagerstown). 2006;7(3):210–5.Google Scholar
  79. 79.
    Villa E. Paediatric video-assisted thoracoscopic clipping of patent ductus arteriosus: experience in more than 700 cases. Eur J Cardiothorac Surg. 2004;25(3):387–93.PubMedGoogle Scholar
  80. 80.
    Burke RP. Video-assisted thoracoscopic surgery for patent ductus arteriosus in low birth weight neonates and infants. Pediatrics. 1999;104(2 Pt 1):227–30.PubMedGoogle Scholar
  81. 81.
    Muralidhar KS, Shetty DP. Ventilation strategy for video-assisted thoracoscopic clipping of patent ductus arteriosus in children. Paediatr Anaesth. 2001;11(1):45–8.PubMedGoogle Scholar
  82. 82.
    Miyagi K. One-lung ventilation for video-assisted thoracoscopic interruption of patent ductus arteriosus. Surg Today. 2004;34(12):1006–9.Google Scholar
  83. 83.
    Odegard KC. Intraoperative recurrent laryngeal nerve monitoring during video-assisted throracoscopic surgery for patent ductus arteriosus. J Cardiothorac Vasc Anesth. 2000;14(5):562–4.PubMedGoogle Scholar
  84. 84.
    Clark DC. Esophageal atresia and tracheoesophageal fistula. Am Fam Physician. 1999;59(4):910–6; 919–20.Google Scholar
  85. 85.
    Keckler SJ, St Peter SD, Valusek PA, Tsao K, Snyder CL, ­Holcomb GW 3rd, Ostlie DJ. VACTERL anomalies in patients with esophageal atresia: an updated delineation of the spectrum and review of the literature. Pediatr Surg Int. 2007;23(4):309–13. Epub 2007 Feb 15.Google Scholar
  86. 86.
    Geneviève D, de Pontual L, Amiel J, Sarnacki S, Lyonnet S. An overview of isolated and syndromic oesophageal atresia. Clin Genet. 2007;71(5):392–9.PubMedGoogle Scholar
  87. 87.
    Spitz L. Oesophageal atresia. Orphanet J Rare Dis. 2007;2:24.PubMedGoogle Scholar
  88. 88.
    Gross RE. The surgery of infancy and childhood. WB Saunders: Philadelphia; 1953.Google Scholar
  89. 89.
    Okamoto T, Takamizawa S, Arai H, Bitoh Y, Nakao M, Yokoi A, Nishijima E. Esophageal atresia: prognostic classification revisited. Surgery. 2009;145(6):675–81. Epub 2009 Apr 11.Google Scholar
  90. 90.
    Aziz D, Chait P, Kreichman F, Langer JC. Image-guided percutaneous gastrostomy in neonates with esophageal atresia. J Pediatr Surg. 2004;39(11):1648–50.PubMedGoogle Scholar
  91. 91.
    Krosnar S, Baxter A. Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula: anesthetic and intensive care management of a series of eight neonates. Paediatr Anaesth. 2005;15(7):541–6.PubMedGoogle Scholar
  92. 92.
    Lugo B, Malhotra A, Guner Y, Nguyen T, Ford H, Nguyen NX. Thoracoscopic versus open repair of tracheoesophageal fistula and esophageal atresia. J Laparoendosc Adv Surg Tech A. 2008;18(5):753–6.PubMedGoogle Scholar
  93. 93.
    Orford J. Advances in the treatment of oesophageal atresia over three decades: the 1970s and the 1990s. Pediatr Surg Int. 2004;20(6):402–7. Epub 2004 May 18.Google Scholar
  94. 94.
    Narang S, Harte BH, Body SC. Anesthesia for patients with a mediastinal mass. Anesthesiol Clin N Am. 2001;19:559–79.Google Scholar
  95. 95.
    Takeda SI, Miyoshi S, Akashi A, Ohta M, Minami M, Okumura M, et al. Clinical spectrum of primary mediastinal tumors: a comparison of adult and pediatric populations at a single Japanese institution. J Surg Oncol. 2003;83:24–30.PubMedGoogle Scholar
  96. 96.
    Davis RD, Oldham NH, Sabiston DC. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management and results. Ann Thorac Surg. 1987;44:229–37.PubMedGoogle Scholar
  97. 97.
    Sairanen H, Leijala M, Louhimo I. Primary mediastinal tumors in children. Eur J Cardiothorac Surg. 1987;1:148–51.PubMedGoogle Scholar
  98. 98.
    Azarow KS, Pearl RH, Zurcher R, Edwards FH, Cohen AJ. Primary mediastinal masses: a comparison of adult and pediatric populations. J Thorac Cardiovasc Surg. 1993;106:67–72.PubMedGoogle Scholar
  99. 99.
    Shamberger RC, Holzman RS, Griscom NT, Tarbell NJ, Weinstein HJ. CT quantification of tracheal cross sectional area as a guide to the surgical and anesthetic management of children with anterior mediastinal mass. J Pediatr Surg. 1991;26:138–42.PubMedGoogle Scholar
  100. 100.
    Sakakeeny-Zaal K. Pediatric orthopnea and total airway ­obstruction. Am J Nurs. 2007;107:40–3.PubMedGoogle Scholar
  101. 101.
    Slinger P, Karsli C. Management of the patient with a large anterior mediastinal mass: recurring myths (Editorial). Curr Opin Anaesthesiol. 2007;20:1–3.PubMedGoogle Scholar
  102. 102.
    Hack HA, Wright NB, Wynn RF. The anaesthetic management of children with anterior mediastinal masses. Anaesthesia. 2008;63(8):837–46.PubMedGoogle Scholar
  103. 103.
    Bechard P, Letourneau L, Lacasse Y, Cote D, Bussieres JS. Perioperative cardiorespiratory complications in adults with mediastinal mass: incidence and risk factors. Anesthesiology. 2004;100:826–34.PubMedGoogle Scholar
  104. 104.
    Victory RA, Casey W, Doherty P, Breatnach F. Cardiac and respiratory complications of mediastinal lymphomas. Anaesth Intens Care. 1993;21:366–9.Google Scholar
  105. 105.
    Sanborn PA, Michna E, Zurokowski D, Burrows PE, Fontaine PJ, Connor L, et al. Adverse cardiovascular and respiratory events during sedation of pediatric patients for imaging examinations. Radiology. 2005;237:288–94.PubMedGoogle Scholar
  106. 106.
    Bailey PL, Pace NL, Ashburn MA, Moll JW, East KA, Stanley TH. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology. 1990;73:826–30.PubMedGoogle Scholar
  107. 107.
    Anghelescu DL, Burgoyne LL, Liu T, Li CS, Pui CH, Hudson MM, et al. Clinical and diagnostic imaging findings predict anesthetic complications in children presenting with malignant mediastinal masses. Paediatr Anaesth. 2007;17:1090–8.PubMedGoogle Scholar
  108. 108.
    Rice TW, Rodriguez RM, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine. 2006;85:37–42.PubMedGoogle Scholar
  109. 109.
    Arya LS, Narain S, Tomar S, Thavaraj V, Dawar R, Bhargawa M. Superior vena cava syndrome. Indian J Pediatr. 2002;69:293–7.PubMedGoogle Scholar
  110. 110.
    Lam JCM, Chui CH, Jacobsen AS, Tan AM, Joseph VT. When is a mediastinal mass critical in a child? An analysis of 29 children. Pediatr Surg Int. 2004;20:180–4.PubMedGoogle Scholar
  111. 111.
    Azizkhan RG, Dudgeon DL, Buck JR, Colombani PM, Yaster M, Nichols D, et al. Life-threatening airway obstruction as a complication to the management of mediastinal masses in children. J Pediatr Surg. 1985;20(6):816–22.PubMedGoogle Scholar
  112. 112.
    Chaignaud BE, Bonsack TA, Kozakewich HP, Shamberger RC. Pleural effusions in lymphoblastic lymphoma: a diagnostic alternative. J Pediatr Surg. 1998;33:1355–7.PubMedGoogle Scholar
  113. 113.
    Das DK. Serous effusions in malignant lymphomas: a review. Diagn Cytopathol. 2006;3:335–47.Google Scholar
  114. 114.
    Güllüoğlu MG, Kiliçaslan Z, Toker A, Kayalci G, Yilmazbayhan D. The diagnostic value of image guided percutaneous fine needle aspiration biopsy in equivocal mediastinal masses. Langenbecks Arch Surg. 2006;39:222–7.Google Scholar
  115. 115.
    Chait P, Rico L, Amaral J, Connolly B, John P, Temple M. Ultrasound-guided core biopsy of mediastinal masses in children. Pediatr Radiol. 2005;35:S76.Google Scholar
  116. 116.
    Lachar W, Shahab I, Saad A. Accuracy and cost-effectiveness of core needle biopsy in the evaluation of suspected lymphoma: a study of 101 cases. Arch Pathol Lab Med. 2007;131:1033–9.PubMedGoogle Scholar
  117. 117.
    Annessi V, Paci M, Ferrari G, Sgarbi G. Ultrasonically guided biopsy of mediastinal masses. Interact Cardiovasc Thorac Surg. 2003;2:319–21.PubMedGoogle Scholar
  118. 118.
    Gupta A, Kumar A, Walters S, Chait P, Irwin MS, Gerstle JT. Analysis of needle versus open biopsy for the diagnosis of advanced stage pediatric neuroblastoma. Pediatr Blood Cancer. 2006;47:875–9.PubMedGoogle Scholar
  119. 119.
    Borenstein SH, Gerstle T, Malkin D, Thorner P, Filler RM. The effects of prebiopsy corticosteroid treatment on the diagnosis of mediastinal lymphoma. J Pediatr Surg. 2000;35:973–6.PubMedGoogle Scholar
  120. 120.
    Rampello E, Fricia T, Malaguarnera M. The management of tumor lysis syndrome. Nat Clin Pract Oncol. 2006;3:438–47.PubMedGoogle Scholar
  121. 121.
    Neuman GG, Weingarten AE, Abramowitz RM, Kushins LG, Abramson AL, Ladner W. The anesthetic management of a patient with an anterior mediastinal mass. Anesthesiology. 1984;60:144–7.PubMedGoogle Scholar
  122. 122.
    Torchio R, Gulotta C, Perbondi A, Ciacco C, Guglielmo M, Orlandi F, et al. Orthopnea and tidal expiratory flow limitation in patients with euthyroid goiter. Chest. 2003;124:133–40.PubMedGoogle Scholar
  123. 123.
    Hnatiuk OW, Corcoran PC, Sierra P. Spirometry in surgery for anterior mediastinal masses. Chest. 2001;120:1152–6.PubMedGoogle Scholar
  124. 124.
    Vander Els NJ, Sorhage F, Bach AM, Straus DJ, White DA. Abnormal flow volume loops in patients with intrathoracic Hodgkin’s disease. Chest. 2000;117:1256–61.PubMedGoogle Scholar
  125. 125.
    Frawley G, Low J, Brown TCK. Anaesthesia for an anterior mediastinal mass with ketamine and midazolam infusion. Anaesth Intens Care. 1995;23:610–2.Google Scholar
  126. 126.
    Bergman NA. Reduction in resting end-expiratory position of the respiratory system with induction of anesthesia and neuromuscular paralysis. Anesthesiology. 1982;57:14–7.PubMedGoogle Scholar
  127. 127.
    Lin SH, Su NY, Hseu SS, Ting CK, Yien HW, Cheng HC, et al. Anesthetic management of patients with giant mediastinal tumors – a report of two cases. Acta Anaesthesiol Sin. 1999;37:133–9.PubMedGoogle Scholar
  128. 128.
    Riley RH, Raper GD, Newman MAJ. Helium-oxygen and cardiopulmonary bypass standby in anesthesia for tracheal stenosis. Anaesth Intens Care. 1994;22:710–3.Google Scholar
  129. 129.
    Asai T. Emergency cardiopulmonary bypass in a patient with a mediastinal mass. Anaesthesia. 2007;62:859–60.PubMedGoogle Scholar
  130. 130.
    Takeda S, Miyoshi S, Omori K, Okumura M, Matsuda H. Surgical rescue for life-threatening hypoxemia caused by a mediastinal tumor. Ann Thorac Surg. 1999;68:2324–6.PubMedGoogle Scholar
  131. 131.
    Langham Jr MR, Kays DW, Ledbetter DJ, Frentzen B, Sanford LL, Richards DS. Congenital diaphragmatic hernia. Epidemiology and outcome. Clin Perinatol. 1996;23(4):671–88.PubMedGoogle Scholar
  132. 132.
    Deeprest J. Current consequences of prenatal diagnosis of congenital diaphragmatic hernia. J Pediatr Surg. 2006;41(2):423–30.Google Scholar
  133. 133.
    Suita S et al. Fetal stabilization for antenatally diagnosed diaphragmatic hernia. J Pediatr Surg. 1999;34(11):1652–7.PubMedGoogle Scholar
  134. 134.
    Bosenberg AT, Brown RA. Management of congenital diaphragmatic hernia. Curr Opin Anaesthesiol. 2008;21(3):323–31.PubMedGoogle Scholar
  135. 135.
    Bohn D. Congenital diaphragmatic hernia. Am J Respir Crit Care Med. 2002;166:911–5.PubMedGoogle Scholar
  136. 136.
    Vitali SH, Arnold JH. Bench-to-bedside review: ventilator strategies to reduce lung injury – lessons from pediatric and neonatal intensive care. Crit Care. 2005;9(2):177–83. Epub 2004 Nov 4.Google Scholar
  137. 137.
    Wung JT. Congenital diaphragmatic hernia: survival treated with very delayed surgery, spontaneous respiration, and no chest tube. J Pediatr Surg. 1995;Vo1301(No 3):406–9.Google Scholar
  138. 138.
    Boloker J. Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair. J Pediatr Surg. 2002;37:357–66.PubMedGoogle Scholar
  139. 139.
    Kays DW. Detrimental effects of standard medical therapy in congenital diaphragmatic hernia. Ann Surg. 1999;230(3):340–51.Google Scholar
  140. 140.
    Bryner BS et al. Congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: does timing of repair matter? J Pediatr Surg. 2009;44(6):1165–71.PubMedGoogle Scholar
  141. 141.
    Guner YS et al. Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs. venoarterial extracorporeal membrane oxygenation. J Pediatr Surg. 2009;44(9):1691–701.PubMedGoogle Scholar
  142. 142.
    van den Hout L. Can we improve outcome of congenital diaphragmatic hernia? Pediatr Surg Int. 2009;25:733–43.PubMedGoogle Scholar
  143. 143.
    Colvin J et al. Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia. Pediatrics. 2005;116(3):e365–3.Google Scholar
  144. 144.
    Liem NT, Dien TM, Ung NQ. Thoracoscopic repair in the neonatal intensive care unit for congenital diaphragmatic hernia during high-frequency oscillatory ventilation. J Laparoendosc Adv Surg Tech A. 2010;20(1):111–4.PubMedGoogle Scholar
  145. 145.
    Hsu HT et al. Total intravenous anesthesia for repair of congenital diaphragmatic hernia: a case report. Kaohsiung J Med Sci. 2004;20(9):465–9.PubMedGoogle Scholar
  146. 146.
    Liem NT. Thoracoscopic surgery for congenital diaphragmatic hernia: a report of nine cases. Asian J Surg. 2003;26(4):210–2.PubMedGoogle Scholar
  147. 147.
    Nguyen TL, Le AD. Thoracoscopic repair for congenital diaphragmatic hernia: lessons from 45 cases. J Pediatr Surg. 2006;41(10):1713–5.PubMedGoogle Scholar
  148. 148.
    Hussain HK et al. Imaging-guided core biopsy for the diagnosis of malignant tumors in pediatric patients. AJR Am J Roentgenol. 2001;176(1):43–7.PubMedGoogle Scholar
  149. 149.
    Elston WJ et al. Safety of research bronchoscopy, biopsy and bronchoalveolar lavage in asthma. Eur Respir J. 2004;24(3):375–7.PubMedGoogle Scholar
  150. 150.
    Lex C et al. Airway eosinophilia in children with severe asthma: predictive values of noninvasive tests. Am J Respir Crit Care Med. 2006;174(12):1286–91.PubMedGoogle Scholar
  151. 151.
    Regamey N et al. Quality, size, and composition of pediatric endobronchial biopsies in cystic fibrosis. Chest. 2007;131(6):1710–7.PubMedGoogle Scholar
  152. 152.
    Molina-Teran A et al. Safety of endobronchial biopsy in children with cystic fibrosis. Pediatr Pulmonol. 2006;41(11):1021–4.PubMedGoogle Scholar
  153. 153.
    Dishop MK, Mallory GB, White FV. Pediatric lung transplantation: perspectives for the pathologist. Pediatr Dev Pathol. 2008;11(2):85–105.PubMedGoogle Scholar
  154. 154.
    Mahmoud M et al. Dexmedetomidine and ketamine for large anterior mediastinal mass biopsy. Paediatr Anaesth. 2008;18(10):1011–3.PubMedGoogle Scholar
  155. 155.
    Cahill AM et al. CT-guided percutaneous lung biopsy in children. J Vasc Interv Radiol. 2004;15(9):955–60.PubMedGoogle Scholar
  156. 156.
    Gluer S et al. Thoracoscopic biopsy in children with diffuse parenchymal lung disease. Pediatr Pulmonol. 2008;43(10):992–6.PubMedGoogle Scholar
  157. 157.
    Shah PL, Hansell D, Lawson PR, Reid KBM, Morgan C. Pulmonary alveolar proteinosis: clinical aspects and current concepts on pathogenesis. Thorax. 2000;55:67–771.PubMedGoogle Scholar
  158. 158.
    Trapnell BC, Whitsett JA, Nakata K. Mechanisms of disease: pulmonary alveolar proteinosis. N Engl J Med. 2003;349:2527–39.PubMedGoogle Scholar
  159. 159.
    Lippmann M, Mok MS, Wasserman K. Anaesthetic management for children with alveolar proteinosis using extracorporeal circulation. Report of two cases. Br J Anaesth. 1977;49:173–7.PubMedGoogle Scholar
  160. 160.
    Mahut B, de Blic J, Le Bourgeois M, Beringer A, Chevalier JY, Scheinmann P. Partial and massive lung lavages in an infant with severe pulmonary alveolar proteinosis. Pediatr Pulmonol. 1992;13:50–3.PubMedGoogle Scholar
  161. 161.
    Moazam F, Schmidt JH, Chesrown SE, Graves SA, Sauder RA, Drummond J, et al. Total lung lavage for pulmonary alveolar proteinosis in an infant without the use of cardiopulmonary bypass. J Pediatr Surg. 1985;20:398–401.PubMedGoogle Scholar
  162. 162.
    Paschen C, Reiter K, Stanzel F, Teschler H, Griese M. Thera­peutic lung lavages in children and adults. Respir Res. 2005; 6:138.PubMedGoogle Scholar
  163. 163.
    Paquet C, Karsli C. Technique of lung isolation for whole lung lavage in a child with pulmonary alveolar proteinosis. Anesthesiology. 2009;110:190–2.PubMedGoogle Scholar
  164. 164.
    Bliss D, Silen M. Pediatric thoracic trauma. Crit Care Med. 2002;30(11 Suppl):S409–15.PubMedGoogle Scholar
  165. 165.
    Holmes JF, Sokolove PE, Brant WE, Kuppermann N. A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma. Ann Emerg Med. 2002;39(5):492–9.PubMedGoogle Scholar
  166. 166.
    Peclet MH et al. Thoracic trauma in children: an indicator of increased mortality. J Pediatr Surg. 1990;25(9):961–5.PubMedGoogle Scholar
  167. 167.
    Bonadio WA, Hellmich T. Post-traumatic pulmonary contusion in children. Ann Emerg Med. 1989;18(10):1050–2.PubMedGoogle Scholar
  168. 168.
    Karamakar MK, Ho A. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003;54:615–25.Google Scholar
  169. 169.
    Cadzow SP, Armstrong KL. Rib fractures in infants: red alert. J Paediatr Child Health. 2000;36:322–6.PubMedGoogle Scholar
  170. 170.
    Bulloch B et al. Cause and clinical characteristics of rib fractures in infants. Pediatrics. 2000;105(4):E48.PubMedGoogle Scholar
  171. 171.
    Roux P, Fisher RM. Chest injuries in children: an analysis of 100 cases of blunt chest trauma from motor vehicle accidents. J Pediatr Surg. 1992;27(5):551–5.PubMedGoogle Scholar
  172. 172.
    Haxhija EQ, Nöres H, Schober P, Höllwarth ME. Lung contusion-lacerations after blunt thoracic trauma in children. Pediatr Surg Int. 2004;20(6):412–4. Epub 2004 Apr 30.Google Scholar
  173. 173.
    Taira BR et al. Ventilator-associated pneumonia in pediatric trauma patients. Pediatr Crit Care Med. 2009;10(4):491–4.PubMedGoogle Scholar
  174. 174.
    Cullen ML. Pulmonary and respiratory complications of pediatric trauma. Respir Care Clin N Am. 2001;7(1):59–77.PubMedGoogle Scholar
  175. 175.
    Hancock BJ, Wiseman NE. Tracheobronchial injuries in children. J Pediatr Surg. 1991;26(11):1316–9.PubMedGoogle Scholar
  176. 176.
    Grant WJ, Meyers RL, Jaffe RL, Johnson DG. Tracheobronchial injuries after blunt chest trauma in children – hidden pathology. J Pediatr Surg. 1998;33(11):1707–11.PubMedGoogle Scholar
  177. 177.
    Eichelberger MR, Randolph JG. Thoracic trauma in children. Surg Clin N Am. 1981;61(5):1181–97.PubMedGoogle Scholar
  178. 178.
    Toronto Lung Transplant Program, Hospital for Sick Children Statistics 2009 (personal communication).Google Scholar
  179. 179.
    Golianu B, Hammer GB. Pain management for pediatric thoracic surgery. Curr Opin Anaesthesiol. 2005;18:13–21.PubMedGoogle Scholar
  180. 180.
    Nunn JF, Slavin G. Posterior intercostal nerve blocks for pain relief after cholecystectomy. Anatomical basis and efficacy. Br J Anaesth 1980;52:253–60.Google Scholar
  181. 181.
    Gibson MP, Vetter T, Crow JP. Use of continuous retropleural bupivacaine in postoperative pain management for pediatric thoracotomy. J Pediatr Surg. 1999;34(1):199–201.PubMedGoogle Scholar
  182. 182.
    Krane EJ, Dalens BJ, Murat I, Murrell D. The safety of epidurals placed during general anesthesia. Reg Anesth Pain Med. 1998;23:433–8.PubMedGoogle Scholar
  183. 183.
    Tsui BC, Seal R, Koller J, Entwistle L, Haugen R, Kearney R. Thoracic epidural analgesia via the caudal approach in pediatric patients undergoing fundoplication using nerve stimulation guidance. Anesth Analg. 2001;93(5):1152–5.PubMedGoogle Scholar
  184. 184.
    Tsui BC. Innovative approaches to neuraxial blockade in children: the introduction of epidural nerve root stimulation and ultrasound guidance for epidural catheter placement. Pain Res Manag. 2006;11(3):173–80.PubMedGoogle Scholar
  185. 185.
    Ingelmo P et al. The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions. Paediatr Anaesth. 2007;17(12):1166–75.PubMedGoogle Scholar
  186. 186.
    Goodarzi M. Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery. Paediatr Anaesth. 1999;9(5):419–22.PubMedGoogle Scholar
  187. 187.
    Serlin S. Single-dose caudal epidural morphine in children: safe, effective, and easy. J Clin Anesth. 1991;3(5):386–90.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Robert Schwartz
    • 1
  • Cengiz Karsli
    • 2
  1. 1.Department of AnesthesiaChildren’s Hospital of Eastern OntarioOttawaCanada
  2. 2.Department of AnesthesiologyThe Hospital for Sick ChildrenTorontoCanada

Personalised recommendations