Anaesthetic management of a preterm neonate with congenital lobar emphysema undergoing left upper lobectomy.

Abstract

Congenital  lobar  emphysema  (CLE)  is  a  rare  congenital  pulmonary  malformation  causing progressive hyperinflation of a pulmonary lobe with compression of the surrounding structures. Anaesthetic  management  is  particularly  challenging  because  positive  pressure  ventilation  may rapidly convert the lesion into a life threatening tension phenomenon. We report the perioperative management of a preterm male neonate , who initially developed respiratory distress syndrome and culture proven neonatal sepsis. After an initial period of clinical stability, he deteriorated on day 14 of  life  with  worsening  respiratory   distress.  Radiological   imaging  confirmed  left  upper   lobe congenital  lobar  emphysema,  for  which  left  upper  lobectomy  was  performed  through  a  left posterolateral  thoracotomy  under  general   anaesthesia.  Anaesthetic  management   focused   on maintaining spontaneous ventilation until thoracotomy to avoid further hyperinflation, minimizing airway pressures after decompression using lung-protective ventilation, and electively continuing postoperative mechanical ventilation.This case highlights the unique anaesthetic challenges of CLE in  a  preterm  neonate,  including  prevention  of  tension  pneumothorax  during  induction,  the impracticality of lung