Management of an infant with diffuse bullous pulmonary lesions using high-frequency oscillatory ventilation

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, conventi onal positive pressure ventilation during laparotomy for intestinal occlusi on led to arterial desaturation. This was corrected by returning to spontan eous respiration and deep inhalation anesthesia with halothane. Based on ou r ICU experience and due to a potential impaired oxygenation during convent ional ventilation, we chose high-frequency oscillatory ventilation (HFOV) f or bilateral sequential thoracotomies for bullectomies at the age of live m onths, We elected the same ventilatory mode for laparotomy for intestinal o bstruction 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 sta bility. 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.