Perioperative management of extremely low-birth weight infants underwent video-assisted thoracoscopic interruption of patent ductus arteriosus: VATS-PDA: 41 cases
Komiya A.,

Objective: Associated with the rise in the survival rate of extremely-low-birth-weight infants(ELBWI) weighing under 1000g, there is an increasing number of cases with indomethacin resistant patent ductus arteriosus (PDA). For these infants, we performed video-assisted thoracoscopic surgery for patent ductus arteriosus (VATS-PDA). Since no report has been published regarding anesthesia for the infants, in the present study, we retrospectively studied perioperative management of ELBWI undergoing VATS-PDA.
Methods: With the approval of institutional ethical review board, forty-one ELBWI who received VATS-PDA from April 2005 to November 2014 were recruited. General anesthesia with sevoflurane and fentanyl were performed in all infants. Intraoperative changes in the blood pressure, heart rate, and SpO2 and frequency of bradycardia were investigated. Data were expressed as mean±SD.
Results: Age of the infants was 24.1±7.5 days, body weight was 753.6±111.6 g, operative time was 28.7±8.2 minutes, and anesthesia time was 83.6±21.3 minutes. At the beginning of anesthesia, the arterial blood pressure was 45.0/25.0±9.6/8.2 mmHg, heart rate was 158.4±15.0 times/min and SpO2 was above 95%. Lowest intraoperative blood pressure was 33.0/19.5±7.5/3.9 mmHg, lowest heart rate was 129±32.0 times/min and lowest SpO2 was 90.1±7.2%. During the surgery, 27 (65.7%) infants received atropine for bradycardia, and 5 (12.2%) infants received a vasopressor for low blood pressure. At the time of leaving the operating room, the blood pressure was 45.5/26.1±10.7/6.8mmHg, showing an increase in the diastolic blood pressure. All infants performed closure of PDA successfully, returned to the NICU and finally discharged after 130.9±74.2 days.
[Discussion] VATS-PDA is proved to be minimally invasive surgery applicable even for ELBWI with indomethacin resistant PDA. In the present study, frequent bradycardia was occurred requiring intravenous atropine administration. Also, during surgery when one lung ventilation was impossible, manual artificial ventilation was mandatory at the time of desaturation by the surgical compression of the lung.
Conclusion: Rapid therapy against bradycardia and hypoxia allowed the safe perioperative management of VATS-PDA in extremely low-birth weight infants.

Perioperative management of extremely low-birth weight infants underwent video-assisted thoracoscopic interruption of patent ductus arteriosus: VATS-PDA: 41 cases