Anaesthesia for repair of neonatal diaphragmatic hernia and eventration: role of ketamine infusion

Abstract

Management of neonates with congenital diaphragmatic defects who have symptoms within hours of birth is still unsatisfactory. The mortality reported for these high-risk infants ranges from 20% to 80%. Anaesthesia for repair of these defects is nonetheless the most perilous phase in these conditions. Surgery often worsens the situation with regard to blood gases. The anaesthesia has to fulfil the criteria for neonatal surgery and thoracic surgery with the added components of elevated pulmonary vascular resistance and pulmonary hypoplasia. The mortality figures are worse if there is lack of a proper neonatal intensive care facility. The management of two such cases is discussed with special stress upon use of the ketamine infusion technique as an alternative safe anaesthetic regime.