How to Get an A for a Nuss Procedure: Management of Arrhythmias, Arrests, Allergies and Analgesia!
By Lauren M. Lobaugh, M.D.
A Nuss procedure is a surgical correction of a pectus excavatum chest wall deformity. It is not a common procedure, so many anesthesiologists are not familiar with it and its possible complications. A Problem-Based Learning Discussion aims to explain the best approaches to anesthetizing a patient undergoing a Nuss procedure.
An important step is the pre-operative workup to ensure patients do not have any metal allergies. This part of the pre-operative workup is often done in the surgeon’s office, so the anesthesiologist may not be aware of the allergy. A thorough history of any cardiac or pulmonary issues also is critical, said Lauren M. Lobaugh, M.D., who will lead the discussion Sunday.
“A lot of people assume that children coming in for a Nuss bar placement are healthy, but there is always a potential for life-threatening complications when you are inserting a giant metal bar,” said Dr. Lobaugh, an Assistant Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Baylor College of Medicine. “Being aware of how that may affect the patient intraoperatively and postoperatively is important.”
It also is vital that family members are informed about potential resuscitation complications with the metal bar in place.
“In the event of a cardiac arrest, how do family members inform health care providers during resuscitation?” Dr. Lobaugh said. “Do they carry a card with them? Do they carry special information to indicate they have a Nuss bar?”
The greatest variation among institutions performing the procedure is the approach to pain management, she said. A thoracic epidural is used at many institutions, but several institutions have adopted an alternative multimodal analgesic pathway.
“At the end of the day, placement of Nuss bar is not a benign procedure. It has risk,” Dr. Lobaugh said. “The complications we will talk about are not going to be your everyday experiences. Just as an anesthesiologist prepares to care for a patient with malignant hypothermia they may not routinely encounter, they need to know what possible issues may arise and how to respond to this.”