Anaesthetic management of a child with congenital lung cyst posted for thoracotomy

Abstract

Congenital pulmonary airway malformations are rare development disorders of the lung mimicking conditions such as congenital lobar emphysema, bronchogenic cyst,                              bronchopulmonary sequestration etc. They can be detected prenatally during ultrasonogram, or may present later in                  infancy or childhood as respiratory distress, infection or                   rupture of the cyst causing pneumothorax. Surgery is the mainstay of treatment. Here we discuss the perioperative management of a ten-year-old child with a lung cyst who initially presented with a pneumothorax like picture. The child was posted for elective thoracotomy and lung cyst resection under general anaesthesia. The main anaesthetic concern was rupture of the cyst with positive pressure ventilation and resultant haemodynamic compromise. We avoided positive pressure ventilation and maintained the child on spontaneous ventilation  till thorax was opened and also avoided  nitrous-oxide           intra-operatively. The intra-operative period was uneventful. The child was extubated on table and post-operative period was uneventful.