[Anesthesia for congenital diaphragmatic hernia].

Although most often passing in silence, anaesthesia for diaphragmatic hernia is none the less the most perilous phase in this condition. Surgery, far from being a salvage procedure, often worsens the situation with regard to blood gases. This anaesthesia must fulfil the criteria of neonatal surgery and a thoracic surgery. In addition to standard measures of surveillance specific to this age group, emphasis must be placed on the need for continuous measurement of blood pressure via an open approach to the right radial artery. Anaesthesia as free of toxicity as possible, of the nitrous oxide-curare type, with low doses of analgesic, offers the maximum security. Ventilation is controlled manually during surgery using a Jackson Rees arrangement (modification of the Ayre type) with surveillance of blood gases. The risk of pneumothorax contralateral to the diaphragmatic hernia could lead to preventive drainage being envisaged in particularly severe forms. This is nevertheless a factor of poor prognosisà Infusion should be reduced to a minimum, between 5 and 7 ml/kg-1/h-1. The dangerous periods of this anaesthesia, in addition to transport and installation of the newborn infant are represented by abdominal closure because of the risk of compression. Patients are left intubated at the end of surgery since postoperative artificial ventilation is a necessity is such cases.