Challenging Anesthesia :

Congenital Heart Disease in Neonate Diaphragmatic Hernia

WibowoArdian, AdiPermanaSeptian

Department of Anaesthesiology and Intensive Therapy, Faculty Of Medicine, Sebelas

Maret University/ Dr. Moewardi General Hospital, Surakarta Central Java, Indonesia

INTRODUCTION

Congenital Diaphragmatic Hernia (CDH) results from pericardioperitoneal canal closure

defect, The incidence: 1/5000 live birthwithmortality rate of 62%.The prevalence of CDH
patients with congenital heart diaseases is 11.3%.

OBJECTIVES

To demonstrateanesthetic management in case congenital heart disease in neonate congenital

diaphragmatic hernia.

CASE

A 1‑day‑old female neonate presented with of CDH, Patent Ductus Arteriosus (PDA), Atrial
Septal Defect (ASD), and Tricuspid Regurgitation(TR). Anesthetic was performed with
preoxygenation, fentanyl IV, induction with sevoflurane and muscle relaxation was achieved
using atracuriumIV. Patientwas maintained on oxygen, sevoflurane, fentanyl IV,and
atracurium IV. The patient was ventilated with a pediatric bains circuit. Hemodynamic was
relative stable until the end of surgery. Patient was kept on ventilator support for 7days post
operatively.

DISCUSSION

Challenges faced during management of this case, included the possibility for reversal of
shunt in the presence of pulmonary hypoplasia, pulmonary hypertension, systemic
hypotension due to mediastinal shift and intra cardiac shuntingwhichlead to hypoxemia.
Ventilation with low tidalvolume, careful intraoperative airway pressures, avoiding
hypovolemia, increasing systemic vascular resistanceand pulmonary vascular resistance to
prevent right to left intra cardiac shunting may have the most significantimpact on survival of
neonate. Postoperative ventilation to avoid barotraumas is used low inspiratory pressure and
low tidal volume.

CONCLUSION

Early antenatal diagnosis, avoiding high airway pressuresduring ventilation and right to left
intra cardiac shunting as well as keepinghemodynamic stabilitycan result in better outcome.

REFERENCES
Hines RL, Marschall KE. Stoelting’s Anesthesia and Co-Existing Disease. Philadelphia:
Elsevier; 2018: 641-43.
Longnecker DE, Brown DL, Newman MF, Zapol WM. Anesthesiology Second Edition. New
York: Mc Graw Hill; 2012: 1177-79.
Miller RD. Miller’s Anesthesia Eight Edition. Philadelphia : Elsevier Saunders; 2015: 2793-
94.

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#REF! ETCO2 HR