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.