Anesthesiology pp 387-393 | Cite as

Anesthesia for Congenital Diaphragmatic Hernia

  • Bobby DasEmail author
  • Nathaniel Lata
  • Ximena Soler


Congenital Diaphragmatic Hernia is a defect in the diaphragm occurring in fetal development. Abdominal contents can herniate through the defect, decreasing lung function. In addition to this direct compression effect, abnormal fetal development further decreases lung function. CDH is associated with several syndromes, associations, and chromosomal abnormalities. Detailed prenatal evaluation is required including lung-to-head ratio, liver position, and total lung volume. Postnatal diagnosis can be made with physical examination and chest x-ray. Pulmonary hypertension, inadequate ventilation, and oxygenation are the main causes of morbidity in these patients. Defects can be operated on during gestation in fetal procedures, with direct repair or endoluminal tracheal occlusion. The patient is now stabilized prior to surgery using techniques including early intubation, ECMO, iNO, or HFOV. Intraoperative management now focuses on reducing ventilator related barotrauma, permissive hypercapnia, and spontaneous ventilation. These patients may have many comorbidities long-term. Table provides a summary of the perioperative anesthesia management for congenital diaphragmatic hernia.


Congenital diaphragmatic hernia Anesthesia management Pre-operative Intraoperative Post-operative prevalence Genetic counseling Treatment options Prenatal Neonatal Comorbidities Ventilation strategies Nitric oxide Vasodilators Inotropes Pulmonary hypertension 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.University of Missouri, Kansas CityKansas CityUSA
  3. 3.Children’s Mercy HospitalKansas CityUSA
  4. 4.Department of AnesthesiologyCincinnati Children’s HospitalCincinnatiUSA

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