ISSN 2398-2942      

Anesthesia: for ruptured diaphragm

icanis
Contributor(s):

Sheilah Ann Robertson


Introduction



Pathophysiology of diaphragmatic hernia
  • Loss of integrity of diaphragm following traumatic incident allows some of the abdominal viscera to enter the thorax.
  • This results in compression of the lungs which may lead to ventilation/perfusion mismatch and hypoxia if severe.
  • Respiratory compromise may also result from lung contusion, pleural effusion Pleural: effusion such as hemorrhage or chylothorax Chylothorax , restriction of chest wall movement due to rib fractures, or voluntary restriction of chest wall excursion because of pain.
  • Myocardial contusion may cause cardiac dysrhythmias Heart: dysrhythmia resulting in decreased cardiac output and tissue hypoxia. This usually resolves within a few days.
  • Shock Shock , defined as inadequate tissue perfusion and multiple organ dysfunction, frequently follows major trauma. Fluid therapy Fluid therapy , oxygen Nasal oxygen administration and time may be needed for the patient to recover.
    An intact diaphragm is not essential to sustain life
  • It is more important to correct shock, circulatory and respiratory function than operate immediately to correct a ruptured diaphragm.
  • Circumstances necessitating immediate surgery are:
    • Massive abdominal organ displacement into the thorax causing excessive lung compression.
    • Displaced, dilating stomach.
    • Continuing hemorrhage.
    • Ruptured bowel.

Pre-operative assessment

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Pre-medication

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Induction of anaesthesia

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Maintenance of anesthesia

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Recovery

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Wagner A E, Gaynor J S, Dunlop C I et al (1998) Monitoring adequacy of ventilation by capnometry during thoracotomy in dogs. JAVMA 212 (3), 377-379 PubMed.
  • Boudrieau R J, Muir W W (1987) Pathophysiology of traumatic diaphragmatic hernia. Compendium on Continuing Education for the Practicing Veterinarian (4), 379-385, 386 VetMedResource.

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