Perioperative Anesthesia Care for an Infant Presented with Fulminant Respiratory Distress Secondary a Congenital Pulmonary Airway Malformation in a Resource-Constrained Area-A Rare Case Report

Author(s):

Tajera Tageza Ilala*, Gudeta Teku Ayano, Fentaw Belay Muhammed, Mengistu Yinges Kebede and Aschalew Besha Desta

Background: Infantile congenital pulmonary airway malformation is considered a rare congenital malformation occurring in infants. The provision of anesthesia for such infants bears a substantially challenging situation, as it may lead to sudden hemodynamic collapse during the induction of anesthesia, and positive pressure ventilation resulting in hyperin lation of the cystic lesion. Effective airway management requires thorough knowledge and experience in one-lung ventilation and recognition of related complications during pneumonectomy or lobectomy. Case description: A 4 months old male infant presented with worsening fast breathing and grunting of two weeks duration. He was referred from another primary hospital to our institution with the diagnosis of type-I cystic congenital airway malformation and severe acute malnutrition (severe wasting). The infant was in fulminant respiratory distress on oxygen supplementation (nasal cannula, at 5 L/ min) on admission. Chest CT scans con irmed the presence of a large multilocular air-illed cystic lesion in the right lower lung likely congenital cystic adenomatoid malformation type-I. Following a detailed discussion with the patient's family about the risk and bene its of surgical anesthesia, written informed consent was obtained general anesthesia with endobronchial intubation (one lung ventilation) was planned for the right pneumonectomy. The infant was induced with propofol, and direct rigid laryngoscopy was performed to place the endotracheal tube into the left main bronchus, and it was difficult to place the endotracheal tube into the left main bronchus correctly by blind technique on the irst attempt. The infant was desaturated, and we managed it with gently assisted ventilation. Then after managing hypoxia, we use the small size lexible cystoscope to place the endotracheal tube into the left main bronchus. Finally, the correct placement of the left main bronchial tube was achieved with the lexible cystoscopy passed through the 3.5 mm ID cuffed standard endotracheal tube. Conclusion: Surgery may be indicated in higher stages of the lesion, and this may bear a greater challenge on anesthesia management, particularly airway management is critical during one lung ventilation. Lung separation may possess greater challenges and the use of sophisticated devices aiding in proper lung separation, and used for lung separation might solve or minimize the challenges related to one lung ventilation.