Severe desaturation while attempting one-lung ventilation for congenital cystic adenomatoid malformation with respiratory distress syndrome in neonate -A case report-

Abstract

There are many methods for achieving one-lung ventilation (OLV) during thoracic surgery in neonates and the accuracy of OLV may affect postoperative outcome. The authors have performed OLV using a 5 Fr Arndt endobronchial blocker (AEB, Cook Inc., Bloomington, IN, USA) on a neonate diagnosed with congenital cystic adenomatoid malformation and respiratory distress syndrome (RDS) associated with marked mediastinal shift. In spite of sufficient preoxygenation, sudden and severe fall in oxygen saturation had occurred. Since neonates with RDS may develop sudden and severe desaturation, rapid intubation with anticipation of potential difficulty is necessary as well as sufficient preoxygenation.

Keywords: Congenital cystic adenomatoid malformation; Hypoxia; Newborn; One lung ventilation; Respiratory distress syndrome.

Fig. 1

Chest X-ray of the neonate on first day of admission showing multiple cysts and hyperaeration of the right lower lobe with a mediastinal shift to the left (Arrow).

Fig. 2

CT scan showing multiple cyst like lesions with overexpansion in right lower lobe. Mediastinal shift to the left and right pleural effusion are noted. Also, multiple consolidations in right upper lobe and left lung is noted as well (Arrow).