Intraoperative anesthetic management of an infant with a bridging bronchus: A case report

Abstract

A newborn infant was diagnosed with an imperforate anus, and colostomy was performed one day after birth. He exhibited repeated episodes of poor oxygenation during intubation, and a CT scan revealed a bridging bronchus. He was scheduled to undergo sacroperineal repair in the prone position 8 months later. A tracheal tube, with its tip modified to widen the opening, was inserted through the nose. This led to normal oxygenation, even while in the prone position. The surgery was completed without any complications.

The bridging bronchus: A comprehensive review of a rare, potentially life‐threatening congenital airway anomaly associated with cardiovascular defects

“…Of these, cardiovascular congenital anomalies were present in 38 cases (97.4%). The LPAS was the most common cardiovascular congenital anomy, being observed in 24 cases (61.5%) . A LPAS originates from the RPA and passes between the trachea and esophagus (retrotracheal LPA) to reach the hilum of the left lung (Figure I) .…”

“…Review of imaging studies and measurement of the distance to the true carina on CT may allow for better estimation for placement of ETT. The use of a modified ETT as described by Shakuo et al, should be considered. Tube placement should be confirmed with a fiberoptic scope with auscultation of breath sounds in the upper and lower lobes of both lungs.…”

“…Because the airway may be stenosed, careful maneuvering is required during endotracheal intubation to avoid perforation of the airway. Shakuo et al, suggested using endotracheal tubes (ETTs) with modified tips to ensure an adequate safety margin during insertion.…”

“…The LPAS was the most common cardiovascular congenital anomy, being observed in 24 cases (61.5%). 8,9,[20][21][22] A LPAS originates from the RPA and passes between the trachea and esophagus (retrotracheal LPA) to reach the hilum of the left lung ( Figure 1I). 4,8,9,11 6,7,11,23 coarctation of the aorta (four cases; 10.2%) 15,24,25 and tetralogy of Fallot (two cases; 5.1%).…”

“…8,12 The BB was accompanied by extracardiac congenital anomalies in 11 out of the 42 (26.2%) cases included in this study, with the imperforate anus comprising approximately half of these cases. 1,20 Other congenital anomalies observed include Meckel's diverticulum, 1 hypoplastic sacrum, 8,26 horseshoe kidney, 26 hydronephrosis, 7 absent gall bladder, 21 hypoplastic uterus and ovarian abnormalities, 8 and diaphragmatic hernia. 22…”