ABSTRACT
This chapter describes the basic operative approaches to the chest in pediatric thoracic surgery. These approaches include traditional posterolateral thoracotomy, muscle-sparing thoracotomy, axillary thoracotomy, median sternotomy, and thoracoscopy. General endotracheal anesthesia is required for most intrathoracic operations. The notable exception to this rule would be a biopsy in a child with tracheal compression from a giant anterior mediastinal mass. In the traditional posterolateral thoracotomy, the latissimus dorsi muscles and the serratus anterior muscle are divided. Artery forceps are used to elevate each muscle while it is incised with diathermy. Once the intercostal muscles are identified, the scapula is elevated with a retractor. The ribs are palpated and counted. Before closing the chest, posterior rib blocks with bupivicaine above and below the level of the thoracotomy should be performed. Effective systemic analgesia is essential for the patient's comfort and to facilitate early postoperative physiotherapy and mobilization, which will reduce the risk of atelectasis and pulmonary infections.
