Background: The purpose of this study was to assess the safety issues concerning anesthetic management of videoassisted thoracoscopic surgery (VATS) in pediatric patients. Methods: The medical records of 52 pediatric patients undergoing VATS using general anesthesia and one-lung ventilation (OLV) were reviewed. OLV was achieved with a Fogarty catheter (n= 23) or endobronchial intubation (n= 7) in patients< 10 years of age (group Y, n= 30), and using a double-lumen tube (n= 19) or a univent (n= 3) in children aged between 10 and 16 years of age (group O, n= 22). Hypoxemia, hypercarbia, the difference between ETCO2 and PaCO2, and the effect of CO2 insufflation were assessed. Results: A decrease in SpO2 less than 90% was observed in 40% of the group Y, compared to none of the group O (P< 0.05). A hypercarbia (ETCO2> 50 mmHg) was observed more frequently in group Y (40%) than in group O (0%; P< 0.05). The difference between the ETCO2 and PaCO2 was 10.4±8.9 mmHg in group Y and 4.6±3.9 mmHg in group O (P< 0.05). Hypercarbia and acidosis occurred more frequently in patients with CO2 insufflation than those without insufflation in group Y.

Conclusions: Although the anesthesia for VATS in pediatric patients was successfully accomplished, the infants and younger children presented with more intra-operative problems when compared with older children. The anesthetic management for VATS in infants and younger children requires careful and vigilant monitoring.(Korean J Anesthesiol 2010; 59: 99-103)