Anaesthetic Management of congenital Paraoesophageal hernia in an infant: Rare Case

Primary paraesophageal hiatal hernias are uncommon in childhood. These hernias can be present at birth and are most likely caused by anatomical predispositions. The embryologic basis is persistence of one of the two pneumoenteric recesses. Persistence of right recess creates mesothelial lined space within esophageal hiatus. They are usually symptomatic because mobile components of stomach have migrated cephalad into posterior mediastinum through a large sacculated hiatal defect. Organoaxial rotation of stomach may cause partial or complete obstruction. A 6 days old female child presented with complaints of vomiting after feeding. Chest radiograph showed herniated contents .Diagnosis was confirmed by contrast studies. Contrast filled stomach was seen in posterior mediastinum. Naso gastric tube was seen coiled in the stomach. After all routine investigations baby was taken for surgery. After premedication, baby was induced with propofol and sevoflurane. She was intubated with uncuffed ET tube no 3 by Miller blade no 1after giving 4 mg of succinylcholine chloride. Air entry was bilaterally equal, tube fixed at 8 cm. Anaesthesia was maintained on O2 +N2O+Sevo+ Vecuronium and IPPV with JR circuit.Baby was accessed by upper midline incision.Hernia was reduced and Thal fundoplication was done. Diaphragmatic crure were approximated. Paracetamol suppository given for post operative analgesia. Patient reversed and extubated uneventfully and shifted to PICU for post operative monitoring.