Authors: Wauters R P et al.
Pediatric Anesthesia, February 11, 2026.
Perioperative Care for Pediatric Patients Undergoing Lung Surgery: Retrospective Single Center Review.
This retrospective study examined perioperative anesthetic care and outcomes in children undergoing lung surgery at a tertiary pediatric center. Major pulmonary procedures in pediatric patients are relatively uncommon and are typically concentrated in specialized institutions. As a result, detailed anesthetic literature describing clinical practice patterns and outcomes remains limited.
The investigators reviewed cases from January 2014 through 2023 involving children aged 0–16 years who underwent major lung surgery with anesthetic care provided by a pediatric anesthesia team. Patients undergoing surgery for congenital diaphragmatic hernia, esophageal atresia, or pectus excavatum were excluded to focus specifically on primary pulmonary surgical procedures.
A total of 73 pediatric patients were included in the analysis. Slightly more than half of the patients were male (55%), and the median age was 2.8 years with a median weight of 12.9 kg. Congenital pulmonary airway malformation was the most common diagnosis, accounting for 43% of cases. Nearly half of the patients (45%) underwent partial or complete lobectomy.
Surgical techniques were split relatively evenly between video-assisted thoracoscopic surgery (VATS) and open thoracotomy. One-lung ventilation (OLV), an important anesthetic strategy for thoracic procedures, was required in the majority of patients. Specifically, OLV was used in 81% of cases, and bronchial blockers were the most commonly used method to achieve lung isolation.
Perioperative analgesia strategies focused primarily on regional anesthesia. Epidural catheter placement with ropivacaine infusion was used in 71% of patients for postoperative pain control. Intravenous morphine was used less frequently over time following surgery. Morphine administration was reported in 40% of patients on postoperative day 1, decreasing to 34% on day 2, 19% on day 3, 15% on day 4, and 11% on day 5.
Despite the use of regional analgesia, inadequate pain control was reported in 14% of patients. Most children required short-term postoperative critical care monitoring, with approximately 70% admitted to the intensive care unit for one night following surgery.
The overall hospital course was relatively brief, with an average hospital length of stay of approximately eight days.
This study highlights current perioperative management patterns for pediatric lung surgery in a specialized center. The findings demonstrate that lung isolation is frequently required in pediatric thoracic procedures, with bronchial blockers commonly used to facilitate one-lung ventilation. Epidural analgesia remains a preferred technique for perioperative pain management in this patient population.
Key Points
• Pediatric lung surgery is relatively uncommon and typically performed at specialized centers.
• In this study of 73 children, the median age was 2.8 years.
• Congenital pulmonary airway malformation was the most common diagnosis.
• One-lung ventilation was required in 81% of cases, most often achieved with bronchial blockers.
• Epidural analgesia with ropivacaine was used in 71% of patients for perioperative pain control.
• Seventy percent of patients required overnight ICU admission, and average hospital stay was about eight days.
• Despite regional techniques, inadequate pain control occurred in approximately 14% of patients.
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