TRAUMATIC diaphragmatic hernia with abdominal viscera in the thorax often presents a challenge for the anesthesiologist. In the acute phase hypotension and respiratory embarrassment may occur. Later, obstruction, dilation of bowel with gas and fluid, gangrene, strangulation, and perforation may develop if surgical repair is delayed.7,10 Accompanying electrolyte disturbances and shift of the mediastinum from distended viscera may compromise ventilation and circulation during induction of anesthesia. Regurgitation and aspiration are additional serious complications. This study will present clinical and laboratory observations on sudden development of severe hypotension after induction of anesthesia and controlled hyperventilation.
Induction of anesthesia for traumatic diaphragmatic hernia with viscera in the chest is most often performed as follows: (1) intubation of the trachea with a cuffed tube in the awake state under topical anesthesia; (2) "crash" intubation utilizing an ultra-short-acting barbiturate and succinylcholine followed by positive pressure ventilation (IPPV); and (3) general anesthesia