[Bronchial blocking with a balloon wedge pressure Catheter in a small infant].

The need for one-lung ventilation has been increasing even in pediatric patients. However, the trachea is so narrow in pediatric patients that ordinary double-lumen tubes can not be used and there have been many reports on devices or measures to block one lung. We report our experience with a female infant weighing 2 kg who had severe chronic lung disease under mechanical ventilation, and underwent left lung lower lobectomy with one-lung ventilation technique. We chose a balloon wedge pressure catheter to block the left main bronchus, because it has a central lumen through which a guide wire can be passed and sucking is available. The infant was in need of continuous ventilation and the catheter was too soft to be inserted directly. We first inserted an 18G catheter of a needle-catheter assemble outside the tracheal tube through which a guide wire was inserted into the left main bronchus with the aid of direct vision of a 2-mm fiberoptic bronchoscope through the tracheal tube, and then inserted the balloon wedge pressure catheter placing it in an appropriate position. One-lung ventilation was successfully achieved and the operative and postoperative course was uneventful.

[Anesthetic management of an 18-trisomy neonate with high frequency ventilation].

Neonates with 18-trisomy syndrome have various anomalies including cardiac and facial anomalies. Active treatments for them have not been recommended due to a low survival over one year which is less than 10%. However, the survival over one year in our institute between 1985 and 2003 is higher at 22%, and we had a patient with survival of over 5 years. We report a case of anesthetic management in a male 18-trisomy neonate who received a radical repair of umbilical hernia immediately after his birth. Tracheal intubation was difficult due to small airway and facial anomalies; cleft clip, cleft palate, and macrognathia. Conventional ventilation was ineffective for elimination of carbon dioxide and oxygenation due to pulmonary hypoplasia and intra- and extra-cardiac shunts. A high frequency ventilation improved elimination of carbon dioxide and oxygenation.

[Propofol anesthesia for fetal sedation].

We were requested to reduce neonatal respiratory effort at delivery in anesthetic management for Cesarean section. A 26-year-old pregnant woman was suspected through abdominal ultrasound examination and amniotic fluid test, of her baby having immature lungs associated with remarkable pleural effusion. Lungs could be damaged by respiratory effort after delivery, and respiratory management immediately after delivery was planned. Anesthesia was induced with propofol and fentanyl 300 micrograms. Propofol was administered with a target controlled infusion setting with the target blood concentration of 10 micrograms.ml-1. Fetal electrocardiogram was monitored for detecting fetal sedation. The concentrations of propofol at delivery were 10.7 and 4.1 micrograms.ml-1 in maternal arterial and umbilical venous blood, respectively, and the baby was apneic. Respiration of the baby was managed with a high frequency jet ventilation mode, and 160 ml of pleural effusion was aspirated immediately after the delivery. The baby was discharged from the hospital 5 weeks afterward.