What problems may occur intraoperatively and postoperatively?
Meticulous attention should be paid to adequate oxy-genation and ventilation of these neonates. There is an increased risk for pneumothorax, especially on the contralat-eral side. If this should occur it would be life-threatening. Efforts should be made to avoid using ventilation pressures greater than 40 cm H2O to avoid causing a pneumothorax. No attempt should be made to manually inflate the con-tralateral lung because of this potential life-threatening risk. A diagnosis of a pneumothorax should be considered when any abrupt change in the condition of the neonate occurs during surgery. When in doubt of the diagnosis, a needle should be inserted into the contralateral chest. This maneu-ver will both diagnose the presence of a pneumothorax and treat it as well. A chest tube should be placed once the diagnosis is made.
Postoperatively, these neonates may continue to require oxygen and ventilatory support. There may be continued pulmonary hypertension and the patient may continue to deteriorate despite surgical correction. This deterioration is due to the severe degree of pulmonary hypoplasia that existed preoperatively and the change in pulmonary mechanics after surgery.