Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report

Liu Zhang; Xuejie Li

doi:doi:10.11648/j.ajp.20230903.12

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Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report

Liu Zhang, Xuejie Li

Published in American Journal of Pediatrics (Volume 9, Issue 3)

Received: 12 June 2023 Accepted: 28 June 2023 Published: 8 July 2023

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Abstract

Congenital diaphragmatic hernia (CDH) is a rare developmental abnormality involving the partial formation of the diaphragm, which creates an opening that allows abdominal organs to extend into the chest cavity. Children with congenital diaphragmatic hernia often face complications such as lung infection, hypoxia, acid-base imbalance, and electrolyte disorders, due to the occurrence of abdominal organs within the chest cavity and underdeveloped lungs. The standard treatment for children with CDH involves reducing the herniated organs and repairing the diaphragmatic hernia following their birth. Anesthetic management during surgery can be challenging, particularly when addressing large hernias coupled with lung hypoplasia and congenital heart disease. Positive pressure ventilation with a mask during anesthesia induction may cause gastric distension, exacerbating the child's hypoxemia and further worsening circulation. Therefore, preserving spontaneous breathing during anesthesia induction is the ideal choice. We present a case involving the preservation of spontaneous breathing during the induction of anesthesia in a one-year-old child diagnosed with CDH. In this case, a novel approach using a combination of sevoflurane and esketamine is proposed to maintain stable hemodynamics without significant respiratory depression. The combination of sevoflurane and esketamine offers a promising solution for maintaining stable hemodynamics and preserving spontaneous breathing during anesthesia induction. Further research is required to validate the effectiveness of this approach and provide optimal dosing guidelines for different clinical scenarios.

Published in	American Journal of Pediatrics (Volume 9, Issue 3)
DOI	10.11648/j.ajp.20230903.12
Page(s)	114-117
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Congenital Diaphragmatic Hernia (CDH), Esketamine, Anesthesia Induction

References

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[2]	Skari H, Bjornland K, Haugen G, Egeland T, Emblem R. Congenital diaphragmatic hernia: a meta-analysis of mortality factors. J Pediatr Surg. 2000; 35: 1187-97.
[3]	Deprest J, Brady P, Nicolaides K, Benachi A, Berg C, Vermeesch J, et al. Prenatal management of the fetus with isolated congenital diaphragmatic hernia in the era of the TOTAL trial. Semin Fetal Neonatal Med. 2014; 19: 338-48.
[4]	McGivern MR, Best KE, Rankin J, Wellesley D, Greenlees R, Addor MC, et al. Epidemiology of congenital diaphragmatic hernia in Europe: a register-based study. Arch Dis Child Fetal Neonatal Ed. 2015; 100: F137-44.
[5]	Pober BR. Overview of epidemiology, genetics, birth defects, and chromosome abnormalities associated with CDH. Am J Med Genet C Semin Med Genet. 2007; 145C: 158-71.
[6]	Brown RA, Bosenberg AT. Evolving management of congenital diaphragmatic hernia. Paediatr Anaesth. 2007; 17: 713-9.
[7]	Slavotinek AM, Warmerdam B, Lin AE, Shaw GM. Population-based analysis of left-and right-sided diaphragmatic hernias demonstrates different frequencies of selected additional anomalies. Am J Med Genet A. 2007; 143A: 3127-36.
[8]	Cigdem MK, Onen A, Otcu S, Okur H. Late presentation of bochdalek-type congenital diaphragmatic hernia in children: a 23-year experience at a single center. Surgery today. 2007; 37: 642-5.
[9]	Lin AE, Pober BR, Adatia I. Congenital diaphragmatic hernia and associated cardiovascular malformations: type, frequency, and impact on management. Am J Med Genet C Semin Med Genet. 2007; 145C: 201-16.
[10]	Quinney M, Wellesley H. Anaesthetic management of patients with a congenital diaphragmatic hernia. BJA Educ. 2018; 18: 95-101.
[11]	Pober BR. Genetic aspects of human congenital diaphragmatic hernia. Clin Genet. 2008; 74: 1-15.
[12]	The Congenital Diaphragmatic Hernia Study G. Defect Size Determines Survival in Infants With Congenital Diaphragmatic Hernia. Pediatrics. 2007; 120: e651-7.
[13]	Lally KP, Lasky RE, Lally PA, Bagolan P, Davis CF, Frenckner BP, et al. Standardized reporting for congenital diaphragmatic hernia–An international consensus. Journal of Pediatric Surgery. 2013; 48: 2408-15.
[14]	van de Bunt JA, Veldhoen ES, Nievelstein RAJ, Hulsker CCC, Schouten ANJ, van Herwaarden MYA. Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: A case-cohort comparison study. Paediatr Anaesth. 2017; 27: 1091-7.
[15]	Patel D, Talbot C, Luo W, Mulvaney S, Byrne E. The use of esketamine sedation in the emergency department for manipulation of paediatric forearm fractures: A 5 year study. Injury. 2021; 52: 1321-30.

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APA Style

Liu Zhang, Xuejie Li. (2023). Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report. American Journal of Pediatrics, 9(3), 114-117. https://doi.org/10.11648/j.ajp.20230903.12

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ACS Style

Liu Zhang; Xuejie Li. Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report. Am. J. Pediatr. 2023, 9(3), 114-117. doi: 10.11648/j.ajp.20230903.12

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AMA Style

Liu Zhang, Xuejie Li. Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report. Am J Pediatr. 2023;9(3):114-117. doi: 10.11648/j.ajp.20230903.12

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@article{10.11648/j.ajp.20230903.12,
  author = {Liu Zhang and Xuejie Li},
  title = {Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report},
  journal = {American Journal of Pediatrics},
  volume = {9},
  number = {3},
  pages = {114-117},
  doi = {10.11648/j.ajp.20230903.12},
  url = {https://doi.org/10.11648/j.ajp.20230903.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20230903.12},
  abstract = {Congenital diaphragmatic hernia (CDH) is a rare developmental abnormality involving the partial formation of the diaphragm, which creates an opening that allows abdominal organs to extend into the chest cavity. Children with congenital diaphragmatic hernia often face complications such as lung infection, hypoxia, acid-base imbalance, and electrolyte disorders, due to the occurrence of abdominal organs within the chest cavity and underdeveloped lungs. The standard treatment for children with CDH involves reducing the herniated organs and repairing the diaphragmatic hernia following their birth. Anesthetic management during surgery can be challenging, particularly when addressing large hernias coupled with lung hypoplasia and congenital heart disease. Positive pressure ventilation with a mask during anesthesia induction may cause gastric distension, exacerbating the child's hypoxemia and further worsening circulation. Therefore, preserving spontaneous breathing during anesthesia induction is the ideal choice. We present a case involving the preservation of spontaneous breathing during the induction of anesthesia in a one-year-old child diagnosed with CDH. In this case, a novel approach using a combination of sevoflurane and esketamine is proposed to maintain stable hemodynamics without significant respiratory depression. The combination of sevoflurane and esketamine offers a promising solution for maintaining stable hemodynamics and preserving spontaneous breathing during anesthesia induction. Further research is required to validate the effectiveness of this approach and provide optimal dosing guidelines for different clinical scenarios.},
 year = {2023}
}

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TY  - JOUR
T1  - Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report
AU  - Liu Zhang
AU  - Xuejie Li
Y1  - 2023/07/08
PY  - 2023
N1  - https://doi.org/10.11648/j.ajp.20230903.12
DO  - 10.11648/j.ajp.20230903.12
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 114
EP  - 117
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20230903.12
AB  - Congenital diaphragmatic hernia (CDH) is a rare developmental abnormality involving the partial formation of the diaphragm, which creates an opening that allows abdominal organs to extend into the chest cavity. Children with congenital diaphragmatic hernia often face complications such as lung infection, hypoxia, acid-base imbalance, and electrolyte disorders, due to the occurrence of abdominal organs within the chest cavity and underdeveloped lungs. The standard treatment for children with CDH involves reducing the herniated organs and repairing the diaphragmatic hernia following their birth. Anesthetic management during surgery can be challenging, particularly when addressing large hernias coupled with lung hypoplasia and congenital heart disease. Positive pressure ventilation with a mask during anesthesia induction may cause gastric distension, exacerbating the child's hypoxemia and further worsening circulation. Therefore, preserving spontaneous breathing during anesthesia induction is the ideal choice. We present a case involving the preservation of spontaneous breathing during the induction of anesthesia in a one-year-old child diagnosed with CDH. In this case, a novel approach using a combination of sevoflurane and esketamine is proposed to maintain stable hemodynamics without significant respiratory depression. The combination of sevoflurane and esketamine offers a promising solution for maintaining stable hemodynamics and preserving spontaneous breathing during anesthesia induction. Further research is required to validate the effectiveness of this approach and provide optimal dosing guidelines for different clinical scenarios.
VL  - 9
IS  - 3
ER  -

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Author Information

Liu Zhang

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
Xuejie Li

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China

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Plain Text BibTeX RIS

APA Style

Liu Zhang, Xuejie Li. (2023). Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report. American Journal of Pediatrics, 9(3), 114-117. https://doi.org/10.11648/j.ajp.20230903.12

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ACS Style

Liu Zhang; Xuejie Li. Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report. Am. J. Pediatr. 2023, 9(3), 114-117. doi: 10.11648/j.ajp.20230903.12

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AMA Style

Liu Zhang, Xuejie Li. Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report. Am J Pediatr. 2023;9(3):114-117. doi: 10.11648/j.ajp.20230903.12

Copy | Download

@article{10.11648/j.ajp.20230903.12,
  author = {Liu Zhang and Xuejie Li},
  title = {Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report},
  journal = {American Journal of Pediatrics},
  volume = {9},
  number = {3},
  pages = {114-117},
  doi = {10.11648/j.ajp.20230903.12},
  url = {https://doi.org/10.11648/j.ajp.20230903.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20230903.12},
  abstract = {Congenital diaphragmatic hernia (CDH) is a rare developmental abnormality involving the partial formation of the diaphragm, which creates an opening that allows abdominal organs to extend into the chest cavity. Children with congenital diaphragmatic hernia often face complications such as lung infection, hypoxia, acid-base imbalance, and electrolyte disorders, due to the occurrence of abdominal organs within the chest cavity and underdeveloped lungs. The standard treatment for children with CDH involves reducing the herniated organs and repairing the diaphragmatic hernia following their birth. Anesthetic management during surgery can be challenging, particularly when addressing large hernias coupled with lung hypoplasia and congenital heart disease. Positive pressure ventilation with a mask during anesthesia induction may cause gastric distension, exacerbating the child's hypoxemia and further worsening circulation. Therefore, preserving spontaneous breathing during anesthesia induction is the ideal choice. We present a case involving the preservation of spontaneous breathing during the induction of anesthesia in a one-year-old child diagnosed with CDH. In this case, a novel approach using a combination of sevoflurane and esketamine is proposed to maintain stable hemodynamics without significant respiratory depression. The combination of sevoflurane and esketamine offers a promising solution for maintaining stable hemodynamics and preserving spontaneous breathing during anesthesia induction. Further research is required to validate the effectiveness of this approach and provide optimal dosing guidelines for different clinical scenarios.},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Revolutionizing Anesthesia Using Esketamine for Congenital Diaphragmatic Hernia: A Case Report
AU  - Liu Zhang
AU  - Xuejie Li
Y1  - 2023/07/08
PY  - 2023
N1  - https://doi.org/10.11648/j.ajp.20230903.12
DO  - 10.11648/j.ajp.20230903.12
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 114
EP  - 117
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20230903.12
AB  - Congenital diaphragmatic hernia (CDH) is a rare developmental abnormality involving the partial formation of the diaphragm, which creates an opening that allows abdominal organs to extend into the chest cavity. Children with congenital diaphragmatic hernia often face complications such as lung infection, hypoxia, acid-base imbalance, and electrolyte disorders, due to the occurrence of abdominal organs within the chest cavity and underdeveloped lungs. The standard treatment for children with CDH involves reducing the herniated organs and repairing the diaphragmatic hernia following their birth. Anesthetic management during surgery can be challenging, particularly when addressing large hernias coupled with lung hypoplasia and congenital heart disease. Positive pressure ventilation with a mask during anesthesia induction may cause gastric distension, exacerbating the child's hypoxemia and further worsening circulation. Therefore, preserving spontaneous breathing during anesthesia induction is the ideal choice. We present a case involving the preservation of spontaneous breathing during the induction of anesthesia in a one-year-old child diagnosed with CDH. In this case, a novel approach using a combination of sevoflurane and esketamine is proposed to maintain stable hemodynamics without significant respiratory depression. The combination of sevoflurane and esketamine offers a promising solution for maintaining stable hemodynamics and preserving spontaneous breathing during anesthesia induction. Further research is required to validate the effectiveness of this approach and provide optimal dosing guidelines for different clinical scenarios.
VL  - 9
IS  - 3
ER  -

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