Anaesthetic implications of thoracoscopic surgery in children

As the equipment and technique have improved, minimally invasive surgery is being applied to younger and younger children. With the advent of this valuable surgical technique, there are also specific modifications necessary in the anaesthetic technique. When considering the anaesthetic implications of these patients, one must account for both the patient's underlying status as well as physiological derangements induced by the surgical procedure. The following article attempts to address and review the specific anaesthetic implications of thoracoscopic procedures in neonates, infants, and children including the preoperative evaluation, intraoperative care and monitoring, and postoperative issues including analgesia. The techniques of one-lung anaesthesia, commonly required for thoracoscopy, are reviewed as well as consideration of the adverse effects which can occur during thoracoscopy including inadvertent intravascular CO2 embolism.