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VOLUME 19 , ISSUE 1 ( 2015 ) > List of Articles

CASE REPORT

Congenital lobar emphysema: A modified approach to anesthetic management

Nalini Kotekar, Malathi C. Nandihalli, Srinivas H. Thammaiah, Prashanth R. Putran

Keywords : Congenital lobar emphysema, one lung ventilation, thoracotomy

Citation Information : Kotekar N, Nandihalli MC, Thammaiah SH, Putran PR. Congenital lobar emphysema: A modified approach to anesthetic management. Indian J Crit Care Med 2015; 19 (1):47-49.

DOI: 10.4103/0972-5229.148648

License: CC BY-ND 3.0

Published Online: 01-01-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Congenital lobar emphysema (CLE) is a potentially reversible, though life-threatening cause of respiratory distress in neonates. It is a rare developmental anomaly of the lower respiratory tract. A 10-month-old child presented with fever, cough and difficulty in breathing. Respiratory system examination revealed tachypnea with intercostal retraction, decreased breath sounds over the left upper lobe and room air saturation of 95%. Chest radiograph and computed tomography showed hyperinflated left upper zones with mediastinal shift. Left thoracotomy, followed by left upper lobectomy was performed under general anesthesia with one lung ventilation. Oxygen saturation, blood pressure, electrocardiogram and capnogram were continuously monitored. During anesthesia, conventionally positive pressure ventilation is avoided until the diseased lobe is isolated, however we adopted gentle manual ventilation maintaining the airway pressure before thoracotomy as described by Cotι and Payne et al. Successful anesthetic management of CLE can be achieved by proper understanding of pathophysiology, good perioperative monitoring, and adopting novel management strategies.


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