Anesthesia management in neonatal congenital bronchobiliary fistula: case report and literature review
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CASE REPORT
Open Access
Anesthesia management in neonatal congenital bronchobiliary fistula: case report and literature review Hong Yin, Guangyi Zhao, Yingjie Du and Ping Zhao*
Abstract Background: There is very little published literature and none that discussed care in a neonate regarding anesthetic risk and management of neonate with congenital bronchobiliary fistula during thoracoscopy and thoracotomy. This article analyzes related risk factors and literature review from perioperative ventilation, circulation and other aspects of management. Case presentation: A neonate diagnosed as congenital bronchobiliary fistula combined with severe chemical pneumonia, consolidation of the lungs, and infection was facing the risk of anaesthesia under thoracoscopy exploration surgery, who experiened more than 20 days diagnostic period before operation. Many risk factors have led to conversion from minimally invasive surgery to thoracotomy, including persistent hypoxemia, hypercapnia, difficult surgical exposure and extremly difficulty of intraoperative ventilation management. Anesthesia maintenance after conversion to open access remained problematic. Fortunately the patient showed no sign of any adverse CNS effects after 4 months of follow-up. Conclusions: The most prominent anesthesia challenges are hypoxemia, increased airway resistance, impaired ventilation, and the risk of metabolic acidosis. Close cooperation among the entire neonatal medical team is the key factors in successful management of this rare case. Keywords: Congenital bronchobiliary fistula, CBBF, Neonate, Anesthesia, Chemical pneumonia, Hypoxemia, Hypercapnia
Background Congenital bronchialbiliary fistula (CBBF) is a rare anomaly with low morbidity and very high mortality. CBBF is characterized by an abnormal communication between the respiratory tract (trachea or bronchi) and the biliary tract [1]. According to literatures, Only 45 cases of CBBF have been reported [2]. Surgical treatment is the only way to complete recovery. Because of the rarity of CBBF, there is very little published on anesthesia
* Correspondence: [email protected] Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
management other than a single case report but that this was in a 3 years old rather than neonate [3].
Case presentation A 5-day old full-term female baby, delivered by cesarean section, 2880 g of birth weight, was referred to our hospital because of intermittent cyanosis. She had frequent choking with an excessive volume of yellowish-green saliva at the third day of born. Airway examination showed normal mouth opening and neck movements with no facial anomalies. After admission, her respiratory function continued to deteriorate and endotracheal intubation and ventilator assistance became necessary. Tracheal secretion of a large volume of yellowish-green fluid
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptatio
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