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Anesthesia and Analgesia for Pectus Excavatum Surgery

Authors
Journal
Anesthesiology Clinics
1932-2275
Publisher
Elsevier
Volume
32
Issue
1
Identifiers
DOI: 10.1016/j.anclin.2013.10.006
Keywords
  • Pectus Excavatum
  • Nuss Procedure
  • Thoracic Epidural
  • Haller Index
  • Chest Wall Deformities
  • Multimodal Analgesics
Disciplines
  • Medicine

Abstract

The technique of choice for surgical correction of pectus excavatum is the Nuss procedure, a minimally invasive technique in which rigid metal bars are placed transthoracically beneath the sternum and costal cartilages until permanent remodeling of the chest wall has occurred. Intraoperatively, anesthesia focuses on three areas: the potential for catastrophic blood loss caused by perforation of large capacitance vessels and the heart, the potential for malignant arrhythmias, and the consequences of bilateral iatrogenic pneumothoraces. Postoperatively, analgesia is institutionally dependent and controversial, based on usage and type of regional anesthesia. The necessity of multimodal analgesic techniques creates a common ground across different hospital systems.

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