Emergency Thoracotomy for Congenital Lobar Emphysema - Anesthesiology Concerns

Congenital lobar emphysema (CLE) is a rare malformation of lungs, which presents usually in neonatal period or infancy as acute hypoxia and respiratory distress. It is characterized by the lobar over aeration of the normal lung followed by respiratory distress due to partial obstruction of bronchus by ball-valve effect. We would like to present the case of a 3-month-old female preterm (31 weeks) baby who presented to our neonatal intensive care unit with respiratory distress for 1 day. The baby was diagnosed with left-sided CLE having severe mediastinal shift to the right side and a dextroposition heart. Her venous blood gas showed PaCO₂ of 70 mmHg and SpO₂ of 70% with 15 L high-flow nasal oxygen. We would like to highlight the anesthesia techniques of airway management and ventilation during the critical period of induction till thoracotomy and exteriorizing the emphysematous lobe.