[Anesthetic management of four pediatric patients with CCAM for pulmonary lobectomy].

We report perioperative management of four pediatric patients with congenital cystic adenomatoid malformation (CCAM) for pulmonary lobectomy under general anesthesia combined with thoracic epidural anesthesia. The patients were two newborn infants and two infants. A 23-day-old girl whose cyst contained air and a one-day-old girl whose cyst content was drained percutaneously before induction, showed uneventful courses during perioperative period. In a one-yr-old boy with a cyst filled with purulent material, the endotracheal tube became nearly occluded with copious purulent material during operative period, and the management of this case was extremely difficult. After this case, in the other infant case expected to have purulent cyst as the result of repetitive infection, we inserted 5 Fr Fogaty catheter into the orifice of the left inferior bronchus to protect the normal side. This case showed uneventful course during anesthesia. We conclude that anesthesiologists should choose proper airway management method depending on the nature of cystic fluid in these patients.