Anaesthetic Management of Congenital Lobar Emphysema : A Report of Two Cases

Emergency thoracotomy for congenital lobar emphysema – Anesthesiology concerns

Congenital lobar emphysema (CLE) is a rare malformation of lungs, which presents usually in neonatal period or infancy as acute hypoxia and respiratory distress. It is characterized by the lobar over aeration of the normal lung followed by respiratory distress due to partial obstruction of bronchus by ball-valve effect. We would like to present the case of a 3-month-old female preterm (31 weeks) baby who presented to our neonatal intensive care unit with respiratory distress for 1 day. The baby was diagnosed with left-sided CLE having severe mediastinal shift to the right side and a dextroposition heart. Her venous blood gas showed PaCO₂ of 70 mmHg and SpO₂ of 70% with 15 L high-flow nasal oxygen. We would like to highlight the anesthesia techniques of airway management and ventilation during the critical period of induction till thoracotomy and exteriorizing the emphysematous lobe.

Congenital Lobar Emphysema: An Approach of Anesthetic Management

Congenital Lobar Emphysema (CLE) is a medical condition which is quiet rarely seen especially in neonates. The disease is characterized by over inflation of lungs which is produced due to inhibition of escape of inspired air from lungs. This condition usually occurs in infants due to partial obstruction of the bronchus and can be reversed with timely and planned anaesthetic management. Here in, we are presenting a case of an infant who was merely four months of age. CLE was affecting his left upper lobe since birth which was being treated as lobar pneumonia outside at some peripheral health center. The case presented to hospital with the symptoms acute respiratory distress and was taken up for urgent surgical management. Left upper lobectomy was performed which relived his symptoms. Case was discharged from hospital after 10 days of uneventful hospital stay. The case was challenging, as it involved careful and planned anaesthetic management of lung separation as well as prevention of hyperventilation of the un-involved lung.

Congenital lobar emphysema in neonates: Anaesthetic challenges

Congenital lobar emphysema (CLE) is a potentially reversible, though possibly life-threatening, cause of respiratory distress in the neonate. It poses dilemma in diagnosis and management. We are presenting a 6-week-old baby who presented with a sudden onset of respiratory distress related to CLE affecting the left upper lobe. Lobectomy was performed under general anaesthesia with one lung ventilation. The details of anaesthetic challenges and management are described here.