RESUMO
We reported two cases of thoracoscopic diaphragm repair in children. The first case was a 6-day old neonate undergoing thoracoscopic repair of congenital diaphragmatic hernia under general anesthesia. During operation, CO2 was insufflated with a pressure of 4 cmH2O into the thoracic cavity. Although end-tidal CO2 increased to 90 mmHg, Sp(O2) and blood pressure were maintained within normal ranges. The second case was a 20-month-old infant undergoing thoracoscopic repair of diaphragmatic laxity. During operation, end-tidal CO2 increased to around 50 mmHg. Sp(O2) and blood pressure were normal. But during the procedure, insufflation pressure increased up to 10 cmH2O accidentally and arterial blood pressure curve disappeared. Insufflation pressure was corrected quickly and the arterial blood pressure recovered to normal within 10 seconds. The physiological changes of CO2 insufflation in thoracic cavity is similar to tension pneumothorax and we must take care to keep insufflation pressure under 4 cmH2O.
Assuntos
Diafragma/cirurgia , Hérnia Diafragmática/cirurgia , Pneumotórax Artificial/métodos , Toracoscopia , Anestesia Geral , Diafragma/anormalidades , Feminino , Hérnias Diafragmáticas Congênitas , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do TratamentoRESUMO
Upper airway obstruction resulting from overflexion fixation of the cervical spine is a rare but life-threatening complication after cervical spine surgery. There are few reports of dyspnea after a posterior cervical fusion. We present the case of a 63-year-old woman with rheumatoid arthritis who developed an upper airway obstruction immediately after an O-C4 fusion. She was reintubated with a fiberoptic scope. Revision surgery allowing the angle to return to the neutral position was performed to ameliorate the overflexion of the cervical spine fixation and the consequent upper airway obstruction. After revision surgery, the upper airway obstruction disappeared. Our experience suggests that intraoperative use of fluoroscopy and extubation with a tube exchanger are recommended to avoid this complication, especially in patients at high risk of upper airway obstruction.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Vértebras Cervicais/fisiologia , Vértebras Cervicais/cirurgia , Complicações Intraoperatórias/etiologia , Osso Occipital/cirurgia , Fusão Vertebral/métodos , Obstrução das Vias Respiratórias/terapia , Anestesia Geral , Vértebras Cervicais/diagnóstico por imagem , Feminino , Fluoroscopia , Humanos , Complicações Intraoperatórias/terapia , Intubação Intratraqueal , Pessoa de Meia-Idade , Osso Occipital/diagnóstico por imagem , PosturaRESUMO
Laryngotracheo-esophageal cleft is a rare congenital anomaly that occurs when the trachea and esophagus fail to separate during fetal development. Clinical severity varies greatly in anatomic cleft extent. We report the successful management of the airway of a neonate with type IV laryngotracheo-esophageal cleft for the gastric division surgery by dividing the esophagogastric continuity between the esophageal orifice and the stomach using the balloon catheter and remaining spontaneous breathing through the large cuffed tracheal tube inserted into the esophageal orifice.