Congenital Lobar Emphysema: Anaesthetic Challenges and Review of Literature

Abstract

A five-month-old, male child, weighing 5 kg was referred to our hospital for breathlessness. The child had repeated hospitalizations since four months, due to recurrent episodes of fever and gradually worsening respiratory distress. Initial diagnosis of pneumonia was made but the child was unresponsive to medical therapy. On examination, the child was irritable, febrile with marked intercostal and subcostal retractions. His respiratory rate was 52 breaths/ minute and heart rate was 130 beats/minute. On auscultation, decreased air entry was noted in left hemithorax and heart sounds were shifted to right side. Oxygen saturation (SpO 2 ) in room air was 90%. Chest X-ray showed hyperlucency of left upper lobe with mediastinal shift towards right [Table Computed Tomography (CT) scan of chest revealed hyperlucent left upper lobe crossing the midline and subsequent collapse of right upper lobe [Table/Fig-2]. Echocardiography was normal. A diagnosis of CLE of left upper lobe was made and lobectomy was planned. Routine haematological and biochemical investigations were normal. Preoperative Arterial Blood Gas analysis (ABG) revealed: pH 7.45, PaO 2 67 mmHg and PaCO 2 28 mmHg. Oxygen supplementation was continued in preoperative period. The child was kept fasting, according to standard guidelines. No premedication was advised.