Anesthetic management for open reduction and internal fixation of the mandibular fracture in a patient with congenital pulmonary hypoplasia: a case report.

BACKGROUND

Congenital pulmonary hypoplasia is an exceptionally rare developmental disorder that is usually diagnosed in neonates and seldom encountered in adult.Consequently, evidence-based perioperative strategies for adult CPH patients undergoing non-thoracic surgery remain virtually absent. We present a case of an adult with CPH who required general anesthesia for open reduction and internal fixation of the mandibular fracture, and we describe a comprehensive perioperative management plan centered on lung-protective ventilation strategy and multimodal analgesia.

CASE PRESENTATION: This report presents the case of a 46-year-old man with incidentally diagnosed congenital left pulmonary hypoplasia who underwent open reduction and internal fixation of a mandibular fracture. After multidisciplinary evaluation of cardiopulmonary and airway status, surgery was performed under general anesthesia with lung-protective ventilation strategy, multimodal analgesia and restrictive fluid management. Postoperative treatment included intravenous dexmedetomidine-sufentanil continuous analgesia and vigilant respiratory monitoring. The patient was discharged on post-operative day 3 without pulmonary complications.An individualized post-discharge surveillance schedule was arranged that included evaluations at one week, one month, and three months, and no pulmonary complications or other adverse events were identified during the entire three-month follow-up period.At eighteen months after discharge the patient returned for review, chest CT and colour Doppler echocardiography demonstrated stable cardiopulmonary status with no signs of residual complications.

CONCLUSIONS

This case demonstrates that adults with asymptomatic CPH can safely undergo general anesthesia when a meticulous, multidisciplinary pathway is followed. Individualized lung-protective ventilation strategy, restrictive fluid management, and multimodal analgesia effectively averted intra-operative barotrauma, volutrauma and postoperative pulmonary complications.