Anesthetic management of a neonate with giant bronchopulmonary sequestration: A case report

Cho, Ah Reum; Kim, Kyung Hoon; Shin, Sang Wook; Hong, Jung Min; Kim, Hee Young

Case Report

Pediatric Anesthesia

Anesthesia and Pain Medicine 2010;5(4):351-354.
Published online October 31, 2010.

Anesthetic management of a neonate with giant bronchopulmonary sequestration: A case report

Ah Reum Cho, Kyung Hoon Kim, Sang Wook Shin, Jung Min Hong, Hee Young Kim

Department of Anesthesiology and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea. pain@pusan.ac.kr

Abstract

Lung isolation in a neonate can be a challenge for the anesthesiologist. We report on our anesthetic experience with a neonate who had giant bronchopulmonary sequestration (BPS). The BPS was large enough to shift the mediastinum to the contralateral hemithorax. The trachea was immediately intubated after delivery and the lungs were mechanically ventilated in the neonatal intensive care unit. To prevent desaturation during the attempt of lung isolation, a 3 Fr Fogarty catheter was inserted into the trachea alongside the endotracheal tube without extubation. A fiberscope was then passed through the blocker port of a multiport adapter instead of the bronchoscopy port to minimize leakage by tightening the Touhy-Borst valve. Hypoxemia or leakage did not occur during the procedure. For early extubation, we provided caudal analgesia with ropivacaine and morphine. The giant BPS was successfully resected and the neonate was in excellent condition for early extubation. However, reintubation was needed for the pneumothorax caused by the inadequate placement of a chest drain 9 hours after extubation.

Key Words: Bronchopulmonary sequestration, Epidural analgesia, Neonate, One-lung ventilation