2008 Volume 28 Issue 5 Pages 787-791
Infants with congenital diaphragmatic hernia (CDH) have pulmonary hypoplasia resulting in persistent neonatal pulmonary hypertension, a predominant contributor to both high mortality and morbidity. The pulmonary artery bed in patients with CDH is underdeveloped and is very sensitive to even the slightest stimuli. Therefore, it is vital to avoid any factors that might increase pulmonary vascular resistance during perinatal treatment.
We experienced nine cases of anesthesia for cesarean section in patients with prenatally diagnosed CDH. Remifentanil/propofol anesthesia was selected for fetal sedation at birth. The newborn was intubated immediately following birth and ventilated with high frequency oscillation co-administered nitric oxide. Spontaneous breathing and movement of the newborns were restrained in all cases by the transition of remifentanil through the placenta. Remifentanil facilitated neonatal intubation and preoperative general management for newborns with CDH.
