A Delicate Balance: Anesthetic Management for Neonatal Congenital Diaphragmatic Hernia Repair

Congenital diaphragmatic hernia (CDH) presents significant challenges in neonatal management, particularly in the context of anesthesia. This case report details the successful anesthetic management of a five-day-old neonate with left-sided CDH requiring thoracoscopic repair. A five-day-old neonate, delivered via emergency cesarean section due to breech presentation, presented with severe respiratory distress and was diagnosed with left-sided CDH. Initial evaluation revealed respiratory acidosis and moderate pulmonary hypertension. Preoperative stabilization included high-frequency oscillatory ventilation and intravenous infusions of milrinone and vasopressin. Induction was achieved with ketamine and midazolam, along with a left-sided erector spinae block for analgesia. Anesthesia was maintained with intermittent fentanyl boluses during the eight-hour surgery. Ventilation was closely monitored and adjusted for changes in carbon dioxide levels. The surgery was successful, with stable hemodynamics and a smooth recovery. Effective anesthesia in neonates with CDH requires careful preoperative planning and intraoperative vigilance. This case underscores the importance of tailored anesthetic strategies to enhance safety and promote recovery in high-risk pediatric surgeries.