From the Research
Anesthesia for removal of a pectus excavatum bar typically involves general anesthesia with endotracheal intubation, as supported by the most recent and highest quality study 1. The recommended approach begins with standard preoperative assessment and appropriate fasting guidelines.
Key Considerations
- Induction can be achieved with propofol (1.5-2.5 mg/kg), fentanyl (1-2 mcg/kg), and a muscle relaxant such as rocuronium (0.6 mg/kg) to facilitate intubation.
- Maintenance is usually with a volatile anesthetic like sevoflurane (1-2 MAC) or desflurane, supplemented with additional opioids as needed.
- For pain management, a multimodal approach is essential, including preemptive analgesia with acetaminophen (15 mg/kg IV or 1g for adults), ketorolac (0.5 mg/kg up to 30mg), and potentially intercostal nerve blocks with bupivacaine 0.25% (2-3 ml per intercostal space) at the surgical site.
- Postoperative pain control should continue with scheduled acetaminophen, NSAIDs if not contraindicated, and opioids as needed.
Important Complications to Monitor
- The procedure can involve significant pain due to manipulation of the costal cartilages and intercostal nerves, making thorough pain management crucial.
- Close monitoring for pneumothorax is important during the immediate postoperative period, as this is a potential complication of the procedure.
- Patients typically require at least 24 hours of observation following bar removal, as noted in studies such as 2.
Recent Findings
- A study from 2023 3 found that intercostal nerve cryoablation was superior to bupivacaine incisional soaker catheters in reducing hospital length of stay, immediate postoperative pain scores, morphine milliequivalent opioid dosing, postoperative nausea, and constipation.
- Another study from 2022 1 compared non-intubation anesthesia with intubation anesthesia for thoracoscopic-assisted Nuss repair and found that non-intubation anesthesia resulted in less anesthesia intubation time, lower intraoperative mean heart rate, less postoperative complications, and faster postoperative recovery. However, the most relevant and recent study for the removal of a pectus excavatum bar, 1, supports the use of general anesthesia with endotracheal intubation.