title: Emergency Corrective Surgery of Congenital Diaphragmatic Hernia With Pulmonary Hypertension: Prolonged Use of Dexmedetomidine as a Pharmacologic Adjunct.
abstract: BACKGROUND
  Underdevelopment of the lung parenchyma associated with abnormal growth of pulmonary vasculature in neonates with congenital diaphragmatic hernia results in pulmonary hypertension which mandates smooth elective mechanical ventilation in postoperative period, for proper alveolar recruitment and oxygenation, allowing lungs to mature enough for its functional anatomy and physiology. Dexmedetomidine is sympatholytic, reduces pulmonary vascular resistance and exerts sedative and analgesic property to achieve stable hemodynamics during elective ventilation. Neonatal experience with dexmedetomidine has been predominately in the form of short term or procedural use as a sedative.
  
  
  METHODS
  The preliminary clinical experience with pre-induction to 48 hours postoperative use of dexmedetomidine infusion as a pharmacologic adjunct in the emergency corrective surgery of three such neonates are presented.
  
  
  CONCLUSIONS
  Hemodynamics remained virtually stable during the whole procedure and post-operative pain relief and recovery profile were satisfactory. The prolonged infusion was well tolerated with a gradual trend towards improved oxygen saturation. Careful planning of the anesthetic management and the ability to titrate the adjunct utilized for smooth postoperative ventilation are the keys to ameliorate the complications encountered and favorable outcomes achieved in such patients.
authors.affiliation: Department of Anesthesia, Pain Medicine and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Badri Prasad
authors.initials: BP
authors.lastname: Das
authors.affiliation: Department of Anesthesia, Pain Medicine and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Anil Prasad
authors.initials: AP
authors.lastname: Singh
authors.affiliation: Department of Anesthesia, Pain Medicine and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Ram Badan
authors.initials: RB
authors.lastname: Singh
keywords: Congenital Diaphragmatic Hernia; Dexmedetomidine; Neonatal Mechanical Ventilation; Pulmonary Hypertension