Tiny lungs, big challenges: Anaesthetic management of neonatal lobectomy for congenital pulmonary airway malformation – A case series

Dear Editor, Congenital pulmonary airway malformation (CPAM) is a rare cystic lung anomaly that presents unique challenges during anaesthesia in neonates.[1] Risks of cyst rupture, mediastinal shift, impaired venous return, and sudden desaturation necessitate meticulous perioperative planning. With advances in foetal ultrasonography and magnetic resonance imaging (MRI), most cases are now diagnosed antenatally, allowing for a multidisciplinary approach.[2,3] We managed four full-term neonates (mean age 14 days) with antenatally diagnosed CPAM at our tertiary centre between 2024 and 2025 [Figure 1].Figure 1: Contrast-enhanced computed tomography of the chest demonstrating multiple cystic lesions consistent with congenital pulmonary airway malformation in the affected lung lobeAll underwent lobectomy (three left lower lobes, one right upper lobe). Anticipating cyst expansion, bag–mask ventilation was avoided during induction. Anaesthesia was induced intravenously with fentanyl, propofol, and atracurium, followed by smooth tracheal intubation. Maintenance was with sevoflurane in oxygen–air mixture, supplemented with opioids and muscle relaxants. Gentle lung-protective ventilation was employed: tidal volume 6–7 mL/kg, airway pressures