Congenital lobar emphysema (CLE) is a potentially reversible, though life-threatening cause of respiratory distress in neonates. It is a rare developmental anomaly of the lower respiratory tract. A 10-month-old child presented with
fever,
cough and difficulty in breathing. Respiratory system examination revealed
tachypnea with intercostal retraction, decreased breath sounds over the left upper lobe and room air saturation of 95%. Chest radiograph and computed tomography showed hyperinflated left upper zones with mediastinal shift. Left
thoracotomy, followed by left upper lobectomy was performed under
general anesthesia with
one lung ventilation. Oxygen saturation, blood pressure, electrocardiogram and capnogram were continuously monitored. During
anesthesia, conventionally
positive pressure ventilation is avoided until the diseased lobe is isolated, however we adopted gentle manual ventilation maintaining the airway pressure before
thoracotomy as described by Coté and Payne et al. Successful
anesthetic management of CLE can be achieved by proper understanding of pathophysiology, good perioperative monitoring, and adopting novel management strategies.