Work

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

Year: 2025

Type: article

Abstract: 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.

Source: BMC Anesthesiology

DOI: 10.1186/s12871-025-03576-z