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Congenital lobar emphysema: A modified approach to anesthetic management.

Nandihalli MC, Thammaiah SH, Kotekar N, Putran PR - Indian J Crit Care Med (2015)

Bottom Line: 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 Coté 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, JSS Medical College and Hospital, JSS University, Mysore, Karnataka, India.

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 Coté 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.

No MeSH data available.


Related in: MedlinePlus

Emphysematous lobe seen prior resection
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Figure 2: Emphysematous lobe seen prior resection

Mentions: Surgery lasted 90 mins during which left thoracotomy with left upper lobectomy was performed under one lung ventilation and an intercostal drainage tube placed at the left 5th intercostal space in the mid axillary line. Intra-operative findings revealed an emphysematous left upper lobe [Figure 2]. At the end of the procedure, an intercostal block administered using 0.25% bupivacaine 2.5 ml in two intercostals spaces adjacent to the surgical incision. Reversal achieved with neostigmine and Glycopyrrolate. Extubation was done once adequate respiratory efforts were confirmed with the child maintaining a room air saturation of 100%.


Congenital lobar emphysema: A modified approach to anesthetic management.

Nandihalli MC, Thammaiah SH, Kotekar N, Putran PR - Indian J Crit Care Med (2015)

Emphysematous lobe seen prior resection
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296412&req=5

Figure 2: Emphysematous lobe seen prior resection
Mentions: Surgery lasted 90 mins during which left thoracotomy with left upper lobectomy was performed under one lung ventilation and an intercostal drainage tube placed at the left 5th intercostal space in the mid axillary line. Intra-operative findings revealed an emphysematous left upper lobe [Figure 2]. At the end of the procedure, an intercostal block administered using 0.25% bupivacaine 2.5 ml in two intercostals spaces adjacent to the surgical incision. Reversal achieved with neostigmine and Glycopyrrolate. Extubation was done once adequate respiratory efforts were confirmed with the child maintaining a room air saturation of 100%.

Bottom Line: 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 Coté 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, JSS Medical College and Hospital, JSS University, Mysore, Karnataka, India.

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 Coté 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.

No MeSH data available.


Related in: MedlinePlus