Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jul-Sep;11(3):319-326.
doi: 10.4103/sja.SJA_13_17.

Anesthesia for minimally invasive chest wall reconstructive surgeries: Our experience and review of literature

Shagun Bhatia Shah  1 , Uma Hariharan  2 , Ajay Kumar Bhargava  1 , Laleng M Darlong  1
Affiliations
Review

Anesthesia for minimally invasive chest wall reconstructive surgeries: Our experience and review of literature

Shagun Bhatia Shah et al. Saudi J Anaesth. 2017 Jul-Sep.

Abstract

Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum) and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function indices, namely, forced expiratory volume over 1 s, forced vital capacity, vital capacity, and total lung capacity are markedly compromised in pectus excavatum. Earlier, open surgical correction in the form of the Ravitch procedure was followed. Currently, in the era of minimally invasive surgery, Nuss technique (pectus bar procedure) is a promising step in chest wall reconstructive surgery for pectus excavatum. Reverse Nuss is a corrective, minimally invasive surgery for pectus carinatum chest deformity. A tailor-made anesthetic technique for this new procedure has been described here based on the authors' personal experience and thorough review of literature based on Medline, Embase, and Scopus databases search.

Keywords: Epidural anesthesia; Nuss; patient controlled analgesia; pectus carinatum; pectus excavatum; transesophageal echocardiography.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Intraoperative image of bar placement for pectus carinatum
Figure 2
Figure 2
Chest radiograph with two pectus bars in situ
Figure 3
Figure 3
Intraoperative image of pectus bar removal
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Golladay ES, Golladay GJ. Chest wall deformities. Indian J Pediatr. 1997;64:339–50. - PubMed
    1. Chen Z, Amos EB, Luo H, Su C, Zhong B, Zou J, et al. Comparative pulmonary functional recovery after Nuss and Ravitch procedures for pectus excavatum repair: A meta-analysis. J Cardiothorac Surg. 2012;7:101. - PMC - PubMed
    1. Nuss D. Minimally invasive surgical repair of pectus excavatum. Semin Pediatr Surg. 2008;17:209–17. - PubMed
    1. McBride WJ, Dicker R, Abajian JC, Vane DW. Continuous thoracic epidural infusions for postoperative analgesia after pectus deformity repair. J Pediatr Surg. 1996;31:105–7. - PubMed
    1. Goretsky MJ, Kelly RE, Jr, Croitoru D, Nuss D. Chest wall anomalies: Pectus excavatum and pectus carinatum. Adolesc Med Clin. 2004;15:455–71. - PubMed