Anesthetic considerations in an infant with congenital cystic adenomatoid malformation

Congenital cystic adenomatoid malformation (CCAM) is a rare developmental disorder of lower respiratory tract in which child presents with severe respiratory distress, pneumonitis or sepsis. Anesthetic management of such children is challenging owing to hyperinflation or rupture of cystic lesions or iatrogenic pneumothorax with positive pressure ventilation, sudden hemodynamic collapse during induction, excessive bleeding and situation becomes more challenging if child is presenting with sepsis. We report successful management of 42 days old infant with CCAM with pneumonitis and sepsis who underwent lobectomy and was successfully extubated on operating table with meticulous planning and optimum perioperative management. Early extubation is desirable to avoid iatrogenic ventilator induced bronchial stump dehiscence by positive pressure ventilation.