Anesthetic challenges during repairing left pulmonary artery sling without cardiopulmonary bypass: a case report

Abstract

Left pulmonary artery sling (LPAS) is a rare vascular anomaly. The general surgical technique to correct it is through median sternotomy under cardiopulmonary bypass (CPB). In this case, we discuss the anesthetic management of left pulmonary artery (LPA) reimplantation without CPB to improve the understanding and provide an overview for practitioners in managing patients with this rare vascular anomaly. Patient was a 10 months old baby, with main complaints of shortness of breath since he was 4 months old, and diagnosed with LPAS from cardiac multi-slice CT scan (MSCT) examination. Intraoperatively, when the LPA was clamped, the blood pressure decreased due to decreased preload, and the end-tidal CO2 increased to 70 mmHg due to increased dead space, which was successfully managed. Postoperatively, the patient suffered from ventilator acquired pneumonia (VAP). Evaluating and assessing the potential complications that can occur during the perioperative period will help prepare for management and improve the success of anesthetic management. Abbreviations: CPB- Cardiopulmonary Bypass; ETT- Endotracheal Tube; LPA- Left Pulmonary Artery; LPAS- Left Pulmonary Artery Sling; MSCT- Multi-Slice CT Scan; RPA- Right Pulmonary Artery; VAP- Ventilator Acquired Pneumonia Key words: Left Pulmonary Artery; Anesthesia Management; Pulmonary Sling; Cardiopulmonary Bypass Citation: Arifin A, Perdana A. Anesthetic challenges during repairing left pulmonary artery sling without cardiopulmonary bypass: a case report. Anaesth. pain intensive care 2023;27(6):776−779; DOI: 10.35975/apic.v27i6.2352 Received: August 10, 2023; Reviewed: October 16, 2023; Accepted: October 30, 2023