Anesthetic management and perioperative outcomes in infants and young children undergoing diaphragmatic hernia or eventration repair: focus on two lung ventilation and propofol related hemodynamics.

ntroduction To describe anesthetic management and early periopera- tive outcomes in infants and young children undergoing repair of congenital diaphragmatic hernia or diaphrag- matic eventration at a tertiary center, with an exploratory analysis of patients who received propofol for induction. Materials and Methods We retrospectively reviewed 21 children who underwent repair under general anesthesia. Demographic character- istics, comorbidities, anesthetic technique, serial mean arterial pressure (MAP), vasoactive drug use, intraopera- tive complications, and early postoperative outcomes were collected. Propofol-exposed hernia and eventration subgroups were compared exploratorily. Results Fourteen children had hernia and seven had eventration. Conventional two-lung ventilation was used in 20/21 cases. In the propofol-exposed subgroup (n=14), median propofol dose was similar in hernia and eventration pa- tients (6.0 [4.5-6.0] vs 5.0 [5.0-6.0] mg/kg; p=0.895). Ab- solute MAP decline from baseline was also similar. No bradycardia occurred; one hypotension episode was rec- orded. Conclusion In this single-center cohort, diaphragmatic repair was usually managed with intravenous induction, volatile maintenance, and two-lung ventilation. In selected propofol-exposed patients, no clear signal of major im- mediate propofol-related instability was observed. Larger multicenter studies are needed.