Abstract
Purpose
To describe the anesthetic and ventilatory management of an infant with diffuse pulmonary bullous lesions.
Clinical Features
Four successive operations were scheduled for an infant with diffuse pulmonary bullous lesions. At the age of seven weeks, conventional positive pressure ventilation during laparotomy for intestinal occlusion led to arterial desaturation. This was corrected by returning to spontaneous respiration and deep inhalation anesthesia with halothane. Based on our ICU experience and due to a potential impaired oxygenation during conventional ventilation, we chose high-frequency oscillatory ventilation (HFOV) for bilateral sequential thoracotomies for bullectomies at the age of five months. We elected the same ventilatory mode for laparotomy for intestinal obstruction secondary to a polyp at the age of six months. This ventilatory mode was combined with total intravenous anesthesia and epidural analgesia and provided optimal oxygenation and ventilation as well as vital signs stability.
Conclusion
High frequency oscillatory ventilation is a safe technique that may be used in the operating room in cases where conventional ventilation failed to provide satisfactory gas exchange.
Résumé
Objectif
Décrire la technique d’anesthésie et de ventilation chez un enfant souffrant de lésions bulleuses pulmonaires bilatérales.
Aspects cliniques
Un enfant porteur de lésions pulmonaires bulleuses diffuses a dû subir quatre opérations successives. À l’âge de sept semaines, la ventilation habituelle en pression positive utilisée durant une laparotomie pour occlusion intestinale a abouti à une désaturation artérielle. Le traitement a consisté en l’utilisation d’une technique d’anesthésie par inhalation d’halothane en respiration spontanée. En nous basant sur notre expérience aux soins intensifs et sur le fait que la ventilation traditionnelle pourrait provoquer une hypoxie, nous avons choisi d’utiliser la ventilation à haute fréquence par oscillations pour deux thoracotomies séquentielles pour bullectomies à l’âge de cinq mois. Nous avons choisi la même technique de ventilation pour une nouvelle laparotomie pour occlusion intestinale sur un polype à l’âge de six mois. Ce mode ventilatoire associé à une anesthésie intraveineuse totale et à une analgésie épidurale a permis d’assurer l’oxygénation et la ventilation du patient tout en maintenant la stabilité des paramètres vitaux.
Conclusion
La ventilation à haute fréquence par oscillations est une technique sécuritaire et utilisable en salle d’opération lorsque la ventilation classique ne permet pas d’assurer des échanges gazeux satisfaisants.
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Aubin, P., Vischoff, D., Haig, M. et al. Management of an infant with diffuse bullous pulmonary lesions using high-frequency oscillatory ventilation. Can J Anesth 46, 970–974 (1999). https://doi.org/10.1007/BF03013133
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DOI: https://doi.org/10.1007/BF03013133