Workshop C6: Anesthesia for Thoracic Surgery in Children

Prior to the 1990s, nearly all thoracic surgery in children was performed by thoracotomy. In the majority of cases, anesthesiologists ventilated both lungs with a conventional tracheal tube and the surgeons retracted the operative lung in order to gain exposure to the surgical field. During the past decade, the use of video-assisted thoracoscopic surgery (VATS) has dramatically increased in both adults and children. Recent advances in surgical technique as well as technology, including high-resolution microchip cameras and smaller endoscopic instruments, have facilitated the application of VATS in smaller patients. VATS is being used extensively for pleural debridement in patients with empyema, lung biopsy and wedge resections for ILD, mediastinal masses, and metastatic lesions. More extensive pulmonary resections, including segmentectomy and lobectomy, have been performed for lung abscess, bullous disease, sequestrations, lobar emphysema, CAM, and neoplasms. In addition, closure of PDA, repair of hiatal hernias, and anterior spinal fusion are performed with VATS. Although VATS can be performed while both lungs are being ventilated, using CO2 insufflation and placement of a retractor to displace lung tissue in the operative field, single lung ventilation (SLV) is extremely desirable during VATS. There are several different techniques that can be used for SLV in children.