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VOLUME 10 , ISSUE 2 ( May-August, 2021 ) > List of Articles


Anesthetic Challenges During Video-Assisted Thoracoscopic Surgeries for Pediatric Empyema Thoracis: A Case Series

Deepak Dwivedi, Mohit Kumar, Shankar Raman, Vivek Kumar Singh

Keywords : Empyema thoracic, one-lung ventilation, pain postoperative, pediatric, video-assisted thoracoscopic surgery

Citation Information : Dwivedi D, Kumar M, Raman S, Singh VK. Anesthetic Challenges During Video-Assisted Thoracoscopic Surgeries for Pediatric Empyema Thoracis: A Case Series. Indian J Respir Care 2021; 10 (2):226-229.

DOI: 10.4103/ijrc.ijrc_80_20

License: CC BY-NC-SA 4.0

Published Online: 06-12-2022

Copyright Statement:  Copyright © 2021; Indian Journal of Respiratory Care.


Video-assisted thoracoscopic surgery (VATS) is a less invasive approach for thoracoscopic surgery providing better visualization through minimal access. In addition, it offers less postoperative pain, fewer operative complications, and shortened hospital stay. These advantages make VATS ideal for the pediatric age group. Various societies recommend the use of VATS for Stage 2 pulmonary empyema and also in some cases of early Stage 3 where the plane of cleavage exists between the pleura and the exudate. A well-executed one-lung ventilation (OLV) is necessary for a successful VATS; however, performance of OLV and postoperative pain management in children poses a challenging task for an anesthesiologist.

  1. Singh AP, Shukla AK, Sharma P, Shukla J. Surgical management of Stage III pediatric empyema thoracis. Lung India 2018;35:209-14.
  2. Subotic D, Lardinois D, Hojski A. Minimally invasive thoracic surgery for empyema. Breathe (Sheff) 2018;14:302-10.
  3. Menon P, Kanojia RP, Rao KL. Empyema thoracis: Surgical management in children. J Indian Assoc Pediatr Surg 2009;14:85-93.
  4. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 1997;23:293-7.
  5. Misolek H, Karpe J, Copek M, Marcinkowski A, Jastrzebska A, Szelka A, et al. Ipsilateral shoulder pain after thoracic surgery procedures under general and regional anesthesia – A retrospective observational study. Kardiochir Torakochirurgia Pol 2014;11:44-7.
  6. Scarci M, Abah U, Solli P, Page A, Waller D, van Schil P, et al. EACTS expert consensus statement for surgical management of pleural empyema. Eur J Cardiothorac Surg 2015;48:642-53.
  7. Reichert M, Pösentrup B, Hecker A, Schneck E, Pons-Kühnemann J, Augustin F, et al. Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema-an analysis of 217 consecutive patients. Surg Endosc 2018;32:2664-75.
  8. Fabila TS, Menghraj SJ. One lung ventilation strategies for infants and children undergoing video assisted thoracoscopic surgery. Indian J Anaesth 2013;57:339-44.
  9. Piccioni F, Templeton TW, Morris B, Valenza F. Pediatric thoracic anesthesia: Airway management for lung isolation and postoperative analgesia. Pediatr Med 2019;2:23.
  10. Purohit A, Bhargava S, Mangal V, Parashar VK. Lung isolation, one-lung ventilation and hypoxaemia during lung isolation. Indian J Anaesth 2015;59:606-17.
  11. Hale JE, Meador MR, Mossad EB. Lung separation in children: Options and impact on gas exchange and lung compliance. Paediatr Anaesth 2019;29:915-9.
  12. Letal M, Theam M. Paediatric lung isolation. BJA Educ 2017;17:57-62.
  13. Cohen DE, McCloskey JJ, Motas D, Archer J, Flake AW. Fluoroscopic-assisted endobronchial intubation for single-lung ventilation in infants. Paediatr Anaesth 2011;21:681-4.
  14. Karnik PP, Dave NM, Garasia M. Comparison of analgesic efficacy and safety of continuous epidural infusion versus local infiltration and systemic opioids in video-assisted thoracoscopic surgery decortication in pediatric empyema patients. Saudi J Anaesth 2018;12:240-4.
  15. Mercieri M, D'Andrilli A, Arcioni R. Improving postoperative pain management after video-assisted thoracic surgery lung resection contributes to enhanced recovery, but guidelines are still lacking. J Thorac Dis 2018;10:S983-7.
  16. Patel NV, Glover C, Adler AC. Erector spinae plane catheter for postoperative analgesia after thoracotomy in a pediatric patient: A case report. A A Pract 2019;12:299-301.
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