Anaesthetic management for a left pneumonectomy in a child with bronchopleural fistula

The anaesthetic management of a left pneumonectomy in a 18-month-old girl with a bronchopleural fistula is described. An ordinary tracheal tube was slit at the bevel to ensure upper lobe ventilation on right endobronchial intubation. A combination of a bronchial blocker, endobronchial intubation with a slit tube, and nerve blocks for these manoeuvres was used. Pain relief by a thoracic epidural block ensured good physiotherapy and a comfortable postoperative period.

Failed epidural anaesthesia in a patient with Hurler's disease

Failure of epidural anaesthesia in a patient with Hurler's disease is presented. The possibility that epidural anaesthesia may fail due to deposition of mucopolysaccharide in the meninges, or in the epidural space is discussed. A granuloma in the upper trachea and severe choanal stenosis complicated the already difficult airway management.

Anaesthetic management of an infant with anterior mediastinal mass

A substantial mediastinal mass in a small infant can create a dilemma regarding the safest mode of airway management. To ensure safety at all times, we adopted one lung ventilation for fear of compression of the carina and/or both main bronchi. Anaesthesia was maintained at a very light plane by the use of local nerve blocks to secure the airway and epidural analgesia for surgery until the tumour was mobilized.