The purpose of this study was to assess the safety issues concerning anesthetic management of video-assisted thoracoscopic surgery (VATS) in pediatric patients.

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 E_TCO₂ and PaCO₂, and the effect of CO₂ insufflation were assessed.

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 (E_TCO₂ > 50 mmHg) was observed more frequently in group Y (40%) than in group O (0%; P < 0.05). The difference between the E_TCO₂ 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.

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.