Repair of Pectus Excavatum

Pectus excavatum is a congenital chest wall deformity characterized by a sternal depression, which typically begins at the manubrium and ends toward the xiphoid. At young age, the pectus excavatum causes no complaints, but as children become more active when they grow up, symptoms of shortness of breath on exertion, lack of endurance, and exercise tolerance appears. A frequent reason to seek medical attention is cosmetic concern. The most common surgical treatments are the Nuss procedure and the Ravitch procedure. Several modifications of the original operation exists. Compared with the Ravitch operation, the Nuss operation duration is much shorter and had lower blood loss. Length of hospital stay was similar. The overall anesthesia and surgery-related complication rate of the Nuss procedure is between 15% and 20%. A common complication is a small pneumothorax and pleural effusion. Chest tube drainage is not always necessary. Life-threatening complications are estimated to be 0.1%. The most devastating complication, cardiac perforation, is rather seldom. Anesthesiologists should be aware of this. Adequate pain therapy is essential to prevent discomfort and allow coughing, which is important to prevent pulmonary complications. Thoracic epidural is most frequently used as a primary analgesic modality. Compared with Ravitch, Nuss patients also had higher average daily pain scores and received more opioids, although both groups received an thoracic epidural. It is unique that a minimally invasive technique produces more pain. Many alternative pain therapies are possible. A hospital protocol should be established for optimal postoperative care.