One lung ventilation in left sided cystic hygroma: Anaesthesia challenges

Abstract

Cystic hygroma [CH], also called as cavernous lymphangioma is a histologically benign congenital tumor of lymphatic origin. Its presence in the cervical region,most common site [25%] poses multiple challenges to the anaesthetist which includes tumor extension in oral and thoracic cavity, restricted neck movements, airway management, haemorrhage, post-operative respiatory obstruction and coexisting anomalies [down syndrome, turner syndrome, and congenital cardiac defects]. The recommended treatment is surgical excision which can be achieved with no mortality and little morbidity. The advantages of video assisted thoracoscopic surgery (VATS) in children have led to its increased usage over the years. VATS, however requires an efficient technique for one lung ventilation. Today there is an increasing interest in developing the technique for lung isolation to meet the anatomic and physiologic variations in infants and children. Significant differences exist between airways of the neonate and the adult. Anaesthetic management of the airway is challenging in neonates and young infants with large neck mass like huge cystic hygroma because these patients are at risk for sudden complete airway occlusion resulting in hypoventilation and hypoxemia. We report a successful anaesthesia management in an infant undergoing video assisted thoracoscopic excision of cystic hygroma in left side of neck which was extending to anterior mediastinum under general anaesthesia.