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Anesthesia for Nuss Procedures (Pectus Deformity)

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Abstract

Pectus excavatum, one of the most common chest wall deformities, is typically repaired via the Nuss repair, a minimally invasive technique that is associated with significant postoperative pain. Although somewhat controversial, this surgery has generally been found to result in improved cardiopulmonary function and body image in patients undergoing repair. Preoperatively, understanding the degree of cardiopulmonary compromise related to the pectus deformity to properly prepare for surgery is key. Intraoperatively, general endotracheal anesthesia with double lung ventilation is most commonly used. Although rare, the most serious complication is serious cardiovascular injury resulting in significant hemorrhage; careful attention must be paid intra-operatively to monitor for such complications. Post-operatively, patients routinely experience significant postoperative pain. Analgesic modalities used to manage this pain include any combination of the following: patient-controlled analgesia (PCA), epidural, paravertebral blocks, nonsteroidal anti-inflammatory agents (NSAIDs), ketamine, intercostal blocks, acetaminophen and muscle relaxants. Patient generally keep the bar in place for 2–4 years, with removal occurring on an outpatient basis. Table 46.2 provides a summary of anesthesia considerations for the repair of pectus excavatum.

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Authors and Affiliations

  1. Department of Anesthesia and Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Vanessa A. Olbrecht M.D., M.B.A.

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  1. Vanessa A. Olbrecht M.D., M.B.A.
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Correspondence to Vanessa A. Olbrecht M.D., M.B.A. .

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Editors and Affiliations

  1. Hospital University Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA

    Basavana G. Goudra

  2. Department of Anesthesiology, Emory University, Atlanta, Georgia, USA

    Michael Duggan

  3. Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

    Vidya Chidambaran

  4. University Hospitals Birmingham, Birmingham, United Kingdom

    Hari Prasad Krovvidi Venkata

  5. Emory University Hospital, Atlanta, Georgia, USA

    Elizabeth Duggan

  6. University of Alabama at Birmingham, Birmingham, Alabama, USA

    Mark Powell

  7. All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India

    Preet Mohinder Singh

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Olbrecht, V.A. (2018). Anesthesia for Nuss Procedures (Pectus Deformity). In: Goudra, B., et al. Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-74766-8_46

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  • DOI: https://doi.org/10.1007/978-3-319-74766-8_46

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