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Case Reports
. 2016 May 6;6(3):e31880.
doi: 10.5812/aapm.31880. eCollection 2016 Jun.

Emergency Corrective Surgery of Congenital Diaphragmatic Hernia With Pulmonary Hypertension: Prolonged Use of Dexmedetomidine as a Pharmacologic Adjunct

Badri Prasad Das  1 , Anil Prasad Singh  1 , Ram Badan Singh  1
Affiliations
Case Reports

Emergency Corrective Surgery of Congenital Diaphragmatic Hernia With Pulmonary Hypertension: Prolonged Use of Dexmedetomidine as a Pharmacologic Adjunct

Badri Prasad Das et al. Anesth Pain Med. .

Abstract

Introduction: Underdevelopment of the lung parenchyma associated with abnormal growth of pulmonary vasculature in neonates with congenital diaphragmatic hernia results in pulmonary hypertension which mandates smooth elective mechanical ventilation in postoperative period, for proper alveolar recruitment and oxygenation, allowing lungs to mature enough for its functional anatomy and physiology. Dexmedetomidine is sympatholytic, reduces pulmonary vascular resistance and exerts sedative and analgesic property to achieve stable hemodynamics during elective ventilation. Neonatal experience with dexmedetomidine has been predominately in the form of short term or procedural use as a sedative.

Case presentation: The preliminary clinical experience with pre-induction to 48 hours postoperative use of dexmedetomidine infusion as a pharmacologic adjunct in the emergency corrective surgery of three such neonates are presented.

Conclusions: Hemodynamics remained virtually stable during the whole procedure and post-operative pain relief and recovery profile were satisfactory. The prolonged infusion was well tolerated with a gradual trend towards improved oxygen saturation. Careful planning of the anesthetic management and the ability to titrate the adjunct utilized for smooth postoperative ventilation are the keys to ameliorate the complications encountered and favorable outcomes achieved in such patients.

Keywords: Congenital Diaphragmatic Hernia; Dexmedetomidine; Neonatal Mechanical Ventilation; Pulmonary Hypertension.

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Figures

Figure 1.
Figure 1.. Trends of Heart Rate and Mean Blood Pressure
Figure 2.
Figure 2.. Trends of Oxygen Saturation and End-tidal Carbon-Dioxide
See this image and copyright information in PMC

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