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Reporte de caso. Rev Colomb Anestesiol. Corresponding author at: Cra. E-mail address: lorena. This case describes the anesthetic technique used in two symptomatic neonates with a prenatal diagnosis of cystic adenomatoid malformation that underwent surgery under general anesthesia at the San Ignacio University Hospital. One was under one-lung ventilation and ultrasound-guided caudal catheter analgesia and the second one with general anesthesia and two-lung ventilation.
Keywords : Anesthesia general, Infant newborn, Bronchoscopy, Foramen ovale patent, Airway management. Cystic adenomatoid malformations are a rare condition with an incidence of 1 in 10, to 1 in 35, pregnancies. The purpose of this report is to educate about the anesthetic management at the San Ignacio Hospital for patients with a rare condition. The birth weight was 3. The pre-surgical paraclinical tests are described in Table 1.
The ultrasound scan showed a patent foramen ovale, good biventricular function, mild pulmonary hypertension PSAP 35 mmHg. A CT scan is requested prior to the surgical procedure in order to characterize the lesion Fig. For the management of analgesia, a caudal puncture with a pediatric Touhy N 20 needle was performed, and an epidural catheter was advanced up to T6.
This space had been previously marked under ultrasound and high frequency transducer. Bupibucaine 0. This provided adequate respiratory mechanics and early postoperative recovery with hemodynamic stability and no oxygen therapy requirements.
The pathology report of the right upper lobe indicated a Type II cystic adenomatoid malformation and the X-ray control showed adequate pulmonary expansion Fig. Female newborn of The pre-surgical echocardiography findings indicated a 3. The pre-surgical paraclinical tests are shown in Table 1. A chest X-ray and CT scan were performed prior to surgery Fig. The left radial artery was catheterized and the patient had an epicutaneous catheter in position.
The intraoperative bleeding was 15 ml. The pathology report indicated a left lung lower lobule cystic lesion and intralobal pulmonary sequestration. The post-operative control X-ray showed adequate thoracic expansion. The adenomatoid malformation was described for the first time in by Chin Tang and is a low prevalence pathology of unknown etiology.
These cysts develop in the embryonic phase during the pseudoglandular and saccular period from week 7 through 17 of gestation. From the patho-physiological point of view, adenomatoid malformations are thought to be secondary to anomalous tissue proliferation, airway obstruction and dysplasia and metaplasia of the normal tissues. There are two classifications: Stocker separates malformations into five types, based on the lesion's histology and Adzick, based on the size of the cysts found in the lung.
In some cases, antenatal surgery is performed without significant evidence supporting this management. The surgical procedure shall be performed prior to the occurrence of symptoms including respiratory distress, tachypnea, retractions and cyanosis and at an early stage for improved prognosis; this may result in compensatory growth of the lung, reduced risk of spontaneous pneumothorax, infection and malignant transformation. Some series describe the use of video-thoracoscopy resulting in a longer surgical time, with shorter hospital stay, better cosmetic outcomes and less postoperative pain.
The anesthetic challenge in these patients is to maintain hemodynamic stability and adequate saturation during neonatal ventilation in lateral decubitus with open chest. In the previously described cases we discussed two anesthetic techniques with clearly different postoperative results.
In contrast with the second patient in whom the isolation with selective orotracheal tube clinically verified trough auscultation failed to ensure adequate resection of the malformation and resulted in major intraoperative bleeding, permanence of the Shunt and difficult ventilation due to increased airway pressures with considerable CO 2 increase, making extubation impossible at the end of the procedure.
On the other hand, the combined anesthetic technique in the first case managed to reduce the use of the inhaled anesthetic to a small dose of local anesthetic, without causing any hemodynamic changes and facilitating the extubation and the postoperative management of analgesia through a continuous infusion of local anesthetic via the thoracic epidural catheter.
The report of cases was submitted to the medical ethics committee of the San Ignacio University Hospital and endorsed for publication. Protection of human and animal subjects.
The authors state that for this investigation, no experiments have been performed on humans or animals. Confidentiality of data. The authors state that they have followed the protocols of its work center on the publication of patient data.
Right to privacy and informed consent. This document works in the power of the correspondence author. Durell J, Lakhoo K. Congenital cystic lesions of the lung. Early Hum Dev. An assessment of the expanded classification of congenital cystic adenomatoid malformations and their relationship to malignant transformation. Am J Surg Pathol. Calvert JK, Lakhoo K. Antenatally suspected congenital cystic adenomatoid malformation of the lung: postnatal investigation and timing of surgery.
J Pediatr Surg. Sfakianaki A, Copel J. Congenital cystic lesions of the lung: congenital cystic adenomatoid malformatio and bronchopulmonary sequestration. Rev Obstet Gynecol. Antenatal and postnatal management of congenital cystic adenomatoid malformation. Paediatr Resp Rev. Congenital lung malformations: informing best practice. Semin Pediatr Surg. Systematic review and meta-analysis of the postnatal management of congenital cystic lung lesions.
Outcomes after postnatal resection of prenatally diagnosed asymptomatic cystic lung lesions. Rahman N, Lakhoo K. Comparison between open and thoracoscopic resection of congenital lung lesions. Nasr A, Bass J.
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All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Article. Article history: Received 24 November Accepted 21 October Available online 5 December Abstract This case describes the anesthetic technique used in two symptomatic neonates with a prenatal diagnosis of cystic adenomatoid malformation that underwent surgery under general anesthesia at the San Ignacio University Hospital.
Introduction Cystic adenomatoid malformations are a rare condition with an incidence of 1 in 10, to 1 in 35, pregnancies. Case reports Case no.
Case no. Discussion The adenomatoid malformation was described for the first time in by Chin Tang and is a low prevalence pathology of unknown etiology.
Ethics committee The report of cases was submitted to the medical ethics committee of the San Ignacio University Hospital and endorsed for publication.
Ethical disclosures Protection of human and animal subjects. Source of financing None. Conflict of interest The authors have no conflicts of interest to disclose. References 1. How to cite this article.
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Reporte de caso. Rev Colomb Anestesiol. Corresponding author at: Cra. E-mail address: lorena.
Archivos de Bronconeumologia http: www. Other types of articles such as reviews, editorials, special articles, clinical reports, and letters to the Editor are also published in the Journal. It is a monthly Journal that publishes a total of 12 issues, which contain these types of articles to different extents. All manuscripts are sent to peer-review and handled by the Editor or an Associate Editor from the team. The Journal is published both in Spanish and English. Therefore, the submission of manuscripts written in either Spanish or English is welcome. Translators working for the Journal are in charge of the corresponding translations.
CPAMs are considered part of the spectrum of bronchopulmonary foregut malformations. Until recently they were described as congenital cystic adenomatoid malformations CCAM. The estimated incidence is approximately live births and there is a male predominance. The diagnosis is usually either made on antenatal ultrasound, or in the neonatal period on the investigation of progressive respiratory distress 3,4. If large, they may cause pulmonary hypoplasia , with resultant poor prognosis. In cases where the abnormality is small, the diagnosis may not be made for many years or even until adulthood.