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Anesthesiology pp 387-393 | Cite as

Anesthesia for Congenital Diaphragmatic Hernia

  • Bobby Das
  • Nathaniel Lata
  • Ximena Soler
Chapter

Abstract

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.

Keywords

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 

References

  1. 1.
    Golombek SG. The history of congenital diaphragmatic hernia from 1850s to the present. J Perinatol. 2002;22(3):242–6.CrossRefPubMedGoogle Scholar
  2. 2.
    O’Dwyer J. Operation for relief of congenital diaphragmatic hernia. Arch Pediatr. 1889;9:130–2.Google Scholar
  3. 3.
    Pober BR, Russell MK, Ackerman KG. Congenital diaphragmatic hernia overview. GeneReviews. NCBI Bookshelf, National Library of Medicine. 2010;(3):1–29.Google Scholar
  4. 4.
    Dicovery.lifemapsc.com. LifeMap Discovery Medical embryology. Pansky B. In: Schoenwolf G, Bleyl S, Brauer P, et al., editors. Larsen’s human embryology, 5th ed. Philadelphia, PA: Churchill Livingstone; 2014.
  5. 5.
    Bachiller PR, Chou JH, Romanelli TM, Roberts JD. Cote and Lerman’s. A practice of anestheisa for infants and children. 5th edn. p 757–8.Google Scholar
  6. 6.
    Kantarce S, Casavant D, Russell M, Pober BR. Findings from aCGH in patients with CDH: a possible locums for Fryns syndrome. Am J Med Genet. 2006;140A(1):17–23.CrossRefGoogle Scholar
  7. 7.
    Borys D, Taxy J. Congenital diaphragmatic hernia and chromosomal anomalies: autopsy study. Pediatr Dev Pathol. 2004;7(1):35–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Kotecha A, Barbato A, Bush A, Claus F, Davenport M, Midulla F. Congenital diaphragmatic hernia. Eur Respir J. 2012;39(4):820–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Benachi A, Cordier AG, Cannie M, Jani J. Advances in prenatal diagnosis of congenital diaphragmatic hernia. Semin Fetal Neonatal Med. 2014;19(6):331–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Leeuwen L, Fitzgerald D. Congenital diaphragmatic hernia. J Paediatr Child Health. 2014;50(9):667–73.CrossRefPubMedGoogle Scholar
  11. 11.
    Oluyomi-Obi T, Kuret V, Puligandla P, Lodha A, Lee-Robertson H, Ryan G, et al. Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH). J Pediatr Surg. 2016;52(5):881–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Deprest J, Jam J, Van Schoubroeck D. Current consequences of prenatal diagnosis of CDH. J Pediatr Surg. 2006;41(2):423–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Snoek KG, Reiss IK, Greenough A, Capolupo I, Urlesberger B, Tibboel D, et al. Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO consortium consensus—2015 update. Neonatology. 2016;110(1):66–74.CrossRefPubMedGoogle Scholar
  14. 14.
    Ciqdem MK, Onen A, Otcu S, Okur H. Late presentation of Bochdalek-type congenital diaphragmatic hernia in children: a 23-year experience at a single center. Surg Today. 2007;37(8):642–5.CrossRefGoogle Scholar
  15. 15.
    Tovar JA. Congenital diaphragmatic hernia. Orphanet J Rare Dis. 2012;7:1.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Bosenberg A, Brown RA. Management of congenital diaphragmatic hernia. Curr Opin Anaesthesiol. 2008;21(3):323–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Diu M, Mancuso T. Pediatric diseases; congenital diaphragmatic hernia. Stoelting’s Anesthesia and Co-Existing Disease. 2012;6:594–6.Google Scholar
  18. 18.
    Hedrick H. Management of prenatally diagnosed congenital diaphragmatic hernia. Semin Pediatr Surg. 2013;22(1):37–43.CrossRefPubMedGoogle Scholar
  19. 19.
    Boloker J, Bateman DA, Wung JT, Stolar CJ. Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair. J Pediatr Surg. 2002;37(3):357–66.CrossRefPubMedGoogle Scholar
  20. 20.
    Bouchghoul H, Senat MV, Storme L, de Lagausie P, Begue L, Benachi A. Congenital diaphragmatic hernia: does gestational age at diagnosis matter when evaluating morbidity and mortality? Am J Obstet Gynecol. 2015;213(4):535.e1–7.CrossRefGoogle Scholar
  21. 21.
    Shieh HF, Wilson JM, Sheils CA, Smithers CJ, Kharasch VS, Buchmiller TL. Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change morbidity outcomes for high-risk congenital diaphragmatic hernia survivors? J Pediatr Surg. 2017;52(10):22–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Chapman RL, Peterec SM, Bizzarro MJ, Mercurio MR. Patient selection for neonatal extracorporeal membrane oxygenation: beyond severity of illness. J Perinatol. 2009;29(9):606–11.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Finer F, Ehrenkranz R, et al. Inhaled nitric oxide and hypoxic respiratory failure in infants with congenital diaphragmatic hernia. The Neonatal Inhaled Nitric Oxide Study Group (NINOS). Pediatrics. 1997;99(6):838–45.CrossRefGoogle Scholar
  24. 24.
    Peetsold MG, Heij HA, Kneepkens CM, Nagelkerke AF, Huisman J, Gemke RJ. The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity. Pediatr Surg Int. 2009;25(1):1–17.CrossRefPubMedGoogle Scholar

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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