J.Jpn. Surg. Soc.. 79(9): 1209-1214, 1978

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Report on the annual meeting

TEN YEARS' PROGRESS IN RESPIRATORY CARE IN PEDIATRIC THORACIC SURGERY

During the past 10 years, 325 surgical procedures including 86 major intrathoracic operations were performed on 85 pediatric patients with congenital esophageal atresia, esophageal stenosis, diaphragmatic hernia, hiatal hernia, pulmonary cysts, and so forth. During this period, respiratory care in thoracic surgery improved a great deal, especially for the last couple of years with rapid development of mechanical devices.
Pre-anesthetic stabilization of the patients also improved, though marked intraoperative hypoventilation and accidental extubation occurred in 15 and 8 cases respectively. Postoperative respiratoy complications were found in 50% of the major cases and in 1.3% of the minor procedures. In the early period, the pressure-limited ventilator did not work successfully to manage lower airway obstruction with thick mucus. Consequently, 3 cases were lost. Since a specially designed infant-respirator and nebulizer became available providing IMV and CPAP, 5 postoperatively distressed neonates were treated properly and successfully.
Although no pneumothorax was experienced in this series, overinflation of the lung was noticed in 3 cases. In autopsied cases, squamous metaplasia of the tracheal epithelium was observed frequently after endotracheal intubation. Accordingly, the excessive use of intubation should be avoided, particularly in neonates and young infants.

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