Anesthesia for congenital tension cysts of the lung in a newborn infant

We experienced anesthetic management of a 22 days old infant with congenital lung cysts which continued to increase in size following birth and caused marked mediastinal displasement. In this disease there is progressive hyperinflation of one or several cysts of the lung because of air trapping mechanisms and it leads to compression atelectasis, mediastinal shift, impairment of venous return, and cardiopulmonaly dysfunction. Terefore, it is said that positive pressure ventilation is contraindicated before the chest is open and spontanious ventilation should be retained during induction and maintenance of anesthesia. But it is clinically very difficult and may be harmfull. In this case we attempted selective bronchial intubation and unilateral positive ventilation of the opposite lung but failed because of technical problems. We believe this is a usefull method once we are accustomed to the technique. During the operation there were several episodes of hypoxemia and hypercarbia, and pulse oxymeter and transcutaneous oxygen and carbon dioxide tension monitering were very usefull in recognizing these episodes in an early stage.