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[Anesthetic management of four pediatric patients with CCAM for pulmonary lobectomy]
Chikako Nishimoto1, Shinichi Inomata, Shin-ichi Kihara
1Department of Anesthesiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba 305-0006.
Insights
Anesthesiologists must tailor airway management for pediatric congenital cystic adenomatoid malformation (CCAM) surgery based on cyst fluid content. Proper techniques ensure safer perioperative outcomes for these complex cases.
Area of Science:
- Pediatric Anesthesiology
- Thoracic Surgery
- Congenital Lung Abnormalities
Context:
- Congenital cystic adenomatoid malformation (CCAM) is a rare congenital lung malformation requiring surgical intervention.
- Perioperative management of CCAM in infants presents unique anesthetic challenges.
- General anesthesia combined with thoracic epidural anesthesia is a common approach for pulmonary lobectomy in pediatric patients.
Purpose:
- To describe the perioperative anesthetic management of four pediatric patients undergoing pulmonary lobectomy for CCAM.
- To highlight the importance of airway management strategies based on the nature of cystic fluid.
- To evaluate the safety and efficacy of combined general and thoracic epidural anesthesia in this patient population.
Summary:
- Four pediatric patients (two newborns, two infants) with CCAM underwent pulmonary lobectomy.
- Patients with air-filled or percutaneously drained cysts had uneventful courses.
- A case with purulent cyst content led to endotracheal tube occlusion, necessitating advanced airway management, including Fogarty catheter use in subsequent cases with suspected purulent content.
- Successful management depended on adapting airway techniques to the specific characteristics of the cystic fluid.
Impact:
- This study emphasizes the critical role of the anesthesiologist in anticipating and managing potential airway complications during CCAM surgery.
- It underscores the need for individualized anesthetic plans tailored to the specific pathology and potential complications associated with CCAM.
- The findings contribute to improved safety protocols and anesthetic strategies for pediatric patients with CCAM, particularly concerning airway management in the presence of diverse cystic contents.
Abstract:
We report perioperative management of four pediatric patients with congenital cystic adenomatoid malformation (CCAM) for pulmonary lobectomy under general anesthesia combined with thoracic epidural anesthesia. The patients were two newborn infants and two infants. A 23-day-old girl whose cyst contained air and a one-day-old girl whose cyst content was drained percutaneously before induction, showed uneventful courses during perioperative period. In a one-yr-old boy with a cyst filled with purulent material, the endotracheal tube became nearly occluded with copious purulent material during operative period, and the management of this case was extremely difficult. After this case, in the other infant case expected to have purulent cyst as the result of repetitive infection, we inserted 5 Fr Fogaty catheter into the orifice of the left inferior bronchus to protect the normal side. This case showed uneventful course during anesthesia. We conclude that anesthesiologists should choose proper airway management method depending on the nature of cystic fluid in these patients.