TYK380
An infant is in the NICU being managed for CDH, and surgical closure is planned. In discussing management of the case with the anesthesia fellow, you explain that:
a) An increase in the preductal saturation during the case may indicate increased pulmonary vascular resistance
b) Oligohydramnios is commonly seen prenatally in infants with CDH
c) Correction of the CDH usually fully resolves the associated pulmonary hypertension symptoms
d) Herniation of the liver is associated with a poor prognosis
e) In addition to adequate oxygenation, maintenance of a high-normal EtCO2 is important because of associated pulmonary hypertension
Answer
Answer d. Most CDH patients have some degree of pulmonary hypertension related to altered lung development; correcting the herniation does not resolve these findings, although they may improve. In the setting of pulmonary hypertension, hypocarbia and alkalosis probably improve pulmonary vascular resistance and cardiac output. Oligohydramnios is unusual. Herniation of the stomach and liver, as well as a history of polyhydramnios, are associated with a poorer prognosis.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.