Laser ablation for complete obstruction of bronchus\u2014an anaesthetic challenge (two case report)

Abstract

BackgroundPrecise tissue destruction, minimal local inflammation and oedema with laser play useful role in the treatment of life-threatening paediatric airway lesions. Risk of fire in O2-enriched atmosphere makes anaesthesia challenging. Fewer options are available for anaesthetic management of laser ablation for bronchial obstruction in children. Very few reports regarding the use of laser for bronchial obstruction in children are available.Case presentationTwo paediatric patients admitted with difficulty in breathing and coughing. They were diagnosed having unilateral bronchial obstruction. They were posted for bronchoscopic laser ablation of blocked tissue. Anaesthesia was managed with total intravenous anaesthesia and ventilation through side arm of bronchoscope. Complications bleeding and pneumothorax happened in one child. Temporary rise in PaCO2 with fall in PH and PaO2 was also observed. Successful management is presented.ConclusionCareful preoperative evaluation, use of low Fio2, measures to avoid fire hazards due to laser, monitoring SpO2 and EtCO2 and maintaining haemodynamic parameters play key role for successful management of laser for bronchial obstruction.