CASE REPORT OF ANAESTHETIC MANAGEMENT OF BRONCHOGENIC CYST IN 11-MONTH OLD CHILD

Abstract

Introduction: Bronchogenic cysts are foregut-derived cystic malformations of the respiratory tract, are the most common cystic mediastinal lesion in children.Case: We report a case of 11-month old child who presented with repeated lower respiratory tract infections for last 3-4 months. She underwent CT chest which revealed a cystic lesion measuring 2.2 x 1.8 x 2.5cm in the posterior mediastinum. Patient was posted for Right postero-lateral thoracotomy with excision of cyst. Thorough Pre-anaesthetic evaluation was done and antibiotics and bronchodilators were continued. General anaesthesia with one lung ventilation was planned. Patient was intubated with Inj.propofol 10mg, Inj.succinylcholine 10mg and uncuffed no.4 endotracheal tube using no.0 Macintosh blade and Inj.vecuronium 0.4 mg given. Patient was maintained on sevourane+O2+ air. Patient was placed in left lateral position. Right T4 intercostal space postero-lateral incision was taken, right lung collapsed and cyst was tried to excised – suddenly we noticed fall in ETco2, followed by severe bradycardia and hypoxia (Spo2 not recordable) Accidental rent in trachea was noticed. Cardiac massage/Inj.Adrenaline/ventilation with 100% oxygen started. Tracheal rent was sutured. Patient was revived successfully. Surgery later was completed uneventfully. Patient was extubated on table and shifted to Paediatric ICU. CONCLUSION: Airway management in paediatric age group is very challenging to anaesthetist. In our scenario resuscitation from asystole and airway management becomes a vital role.