Anaesthetic management of a paediatric case of Bronchopleural fistula posted for open thoracotomy with decortication

Abstract

Bronchopleural fistula (BPF) is a sinus tract between the mainstem, lobar or segmental bronchus and the pleural space leading to an air leak from the lung into the pleural space. It is associated with significant morbidity and mortality. Managing mechanical ventilation in patient with BPF is a challenging situation for anaesthesiologist. Mean airway pressure should be kept minimal in BPF to reduce air leak flows. This case was more challenging because in paediatric patients’ minimum peak end expiratory pressures (PEEP) should be maintained to prevent atelectasis. Also one lung ventilation which is ideally adviced in BPF is difficult in paediatric patients due to wide variety of pathology, non-availability or limited sizes of lung isolation devices. We report a paediatric case with right sided Broncho pleural fistula posted for open thoracotomy with decortication, successfully managed under general +epidural anaesthesia.