ANESTHETIC TECHNIQUES FOR PEDIATRIC THORACOSCOPY

Background. Since 1981, we have performed 68 thoracoscopic procedures in 62 patients aged 7 months to 21 years. Methods. We reviewed the ane sthetic and ventilation strategy used for each procedure to determine which anesthetic strategies are safe and effective for particular chil dren and conditions. Results. Regional anesthesia with sedation was us ed for six procedures in 5 patients with a mean age of 16 years (range , 9 to 21 years). One patient required conversion to general anesthesi a. General anesthesia with one-lung ventilation was attempted for 18 p rocedures in 17 patients with a mean age of 12 years (range, 7 months to 18 years). Two patients required conversion to two-lung anesthesia secondary to pulmonary intolerance. One of these patients and 2 others required thoracotomy. General anesthesia with two-lung ventilation wa s used for 44 procedures in 41 patients with a mean age of 9 years (ra nge, 1 to 17 years). There were no anesthesia-related difficulties. Co nclusions. Regional anesthesia should be limited to the older, more co operative patient. General anesthesia with one-lung ventilation is use ful in adolescents, as they tolerate collapse of one lung well, and it is particularly desirable for procedures requiring exposure of the me diastinum and for talc pleurodesis. General anesthesia with two-lung v entilation can be used in any age group but is generally necessary for infants and small children, as they often will not tolerate the colla pse of one lung, and in the larger child or adolescent with severe pul monary compromise.