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Congenital diaphragmatic herniation results in unique pathophysiologic changes that may be challenging to manage perioperatively. Anesthesiologists involved in the care of these patients must have a thorough understanding of the disease process and know how to evaluate and manage this condition throughout the perioperative period. This activity reviews the principles and considerations for safe anesthetic administration for patients with a congenital diaphragmatic hernia. It highlights the role of interprofessional teams in achieving perioperative goals and optimizing outcomes. Objectives: Identify the pathophysiologic changes most pertinent to anesthetic concerns for congenital diaphragmatic hernia. Evaluate the role of anesthesia during the prenatal and postnatal stages for congenital diaphragmatic hernia. Assess the preoperative evaluation to be performed before undergoing surgical repair for congenital diaphragmatic hernia. Communicate the general anesthetic considerations for the intraoperative period for congenital diaphragmatic hernia for the interprofessional team to maximize patient outcomes. Access free multiple choice questions on this topic.

Congenital diaphragmatic hernia (CDH) is a rare condition where an incomplete closure of the developing diaphragm results in herniation of the abdominal viscera into the thoracic cavity. The thoracic crowding and increased pressures detrimentally affect the developing cardiopulmonary system. Understanding the pathophysiology, prenatal interventions, postnatal evaluation, and intraoperative considerations is essential to guide perioperative anesthetic care. An overview of the etiology, epidemiology, diagnosis, and general medical management of congenital diaphragmatic hernia is discussed elsewhere.[1]

Patients diagnosed with congenital diaphragmatic hernia have complex needs that require the services of multiple hospital teams to provide optimal treatment and support. Managing the perioperative care of these patients involves extensive cooperation between interprofessional team members. The anesthesia team coordinates closely with the neonatologist ICU, pediatric surgery, and maternal-fetal medicine team regarding medical management and timing of the procedures. Maintaining open and consistent communication with the surgical and ICU teams is key to ensuring the neonate’s medical condition is fully optimized and maximizes the likelihood of a successful procedure. Many other professional teams also take important roles in caring for these patients, including ICU nursing staff, respiratory therapists, geneticists, other physician specialists, developmental psychologists, social workers, and other allied health professionals. A cohesive interprofessional team can effectively achieve high-quality medical care for these infants and provide a source of comfort and confidence for the parents of the neonates. Navigating each of the steps from prenatal care through postoperative management can be very challenging. During this time, the interprofessional teams must provide a unified approach to caring for these infants and communicate that plan clearly to the parents.