(精编)【体外膜肺ECMO精品课件】 Anaesthetic Implications of Congenital Diaphragmatic Hernia.pptVIP

Monitoring Precordial/esophageal stethoscope Continuos ECG monitoring Spo2 both above and below nipple Capnography Inspiratory pressures Frequent ABG: corrections if reqd NIBP Fio2 values CVP monitoring Temperature monitoring : avoid hypothermia Estimation of blood loss Inraop… Mechanical ventilation to maintain- Pao2 of 80-100 mm Hg Paco2 of 25-30 mm Hg O2 sat-95-98% pH- 7.55-7.6, with a RR of 60-120 bpm and low TV FiO2 depending on PaO2 Low airway pressures– @ 15-20 cms of H2O Fluid management Correct deficit : Isolyte P @ 4 ml/kg/hr x no of hrs, its 50% to be given in first hour, 25% in next hour 25% in 3rd hour Maintenance with 5D in N/2 or N/4 @4ml/kg/hr Third space losses with isotonic solution/colloid @8ml/kg/hr Other intraop considerations PNEUMOTHORAX Signs– sudden decrease in compliance Spo2 Hypotension bradycardia ----- immediate ICD Prevention -- low airway pressures to be kept Anaesthetic Implications of Congenital Diaphragmatic Hernia www.anaesthesia.co.in email: anaesthesia.co.in@ Congenital Diaphragmatic Hernia Herniation of abdominal contents in the thoracic cavity thru a cong defect in the diaphragm Respiratory distress and cyanosis - warrants emergency care Associated with multiple cong defects (CVS, CNS) High mortality CDH Incidence:- 1:5000 M:F : 2:1 Lt : Rt : 5:1 Defects in diaphragm Embryology 1st month- single pleuroperitoneal cavity 4 wks - septum transversum dorsal mesentry of foregut meet in midline to form central tendon of diaphragm B\w 4 to 9 wks - pleuroperitoneal membrane forms, thus completing the formn of diaphragm after body wall and cervical myotomes’ (2,3,4) contributions Also at 9 wks – developing gut returns from yolk sac to peritoneal cavity Embryology Thus CDH may result from: Early return of midgut to peritoneal cavity Delayed closure of pleuroperitoneal canal Development of lung Development begins at 4 wks; and airway development b/w 10th to 16th wk, f/b alveolar deve