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lobectomy was performed. The infant was sent to the PICU for further care and transferred to a normal baby room 3 days later. The follow-up chest X-ray showed full expansion of the left upper lung lobe without evidence of residual pneumatocele (Figure 2c).When anesthetizing infants with lung lesions, one of the most important questions is whether positive pressure ventilation will cause cardiopulmonary deterioration. For patients with pneumatoceles, spontaneous ventilation and single lung ventilation (SLV) should be considered (2). In the first case, we tried to keep spontaneous respiration before and after intubation and then move the tracheal tube for SLV without muscle relaxants. However, laryngospasm developed after two intubation attempts. In this situation, intermittent positive pressure ventilation could not be avoided to maintain the oxygen saturations and thereafter, tension pneumatoceles expanded with sudden cardiopulmonary collapse. In this case, multiple percutaneous decompressions effectively restored cardiac output.In the second case, we changed the plan of anesthesia. We used a muscle relaxant and applied low pressure ventilation (not higher then 10 cmH 2 O) so tracheal intubation was smooth. Intentional endobronchial intubation was performed and right side SLV was confirmed by auscultation then fiberoptic bronchoscopy. There was no untoward event during induction or surgery. Although a high frequency oscillator and 14G catheters were available for emergency use, they were not used.Single lung ventilation can be achieved with use of a balloon-tipped bronchial blocker, Univent tube or doublelumen tracheal tube in adults or children. However, a double-lumen tube for infants is usually unavailable (3). Pawar and Marraro (4) reported their experience with small-sized double-lumen tracheal tubes, but these tubes are not widely available. In the second case, SLV was achieved with the use of a normal tube. We deviated the tip to the right and gently pushed the tube into the airway until resistance was felt.In conclusion, anesthesia for infants with pneumatoceles remains a challenge with a risk of possible cardio-pulmonary deterioration. Careful planning and successful airway management are keys to successful practice. Chih-M in LiuReferences 1 Imamoglu M, Cay A, Kosucu P, et al. Pneumatoceles in postpneumonic empyema: an algorithmic approach.

Continuing advances in anesthesiology enable surgeons to perform more and more complex operations. Nowhere is this relation more important than for the patient undergoing thoracic surgery. Specialized anesthetic techniques including safe lung separation, the maintenance of oxygenation during selective one-lung ventilation, and effective postoperative analgesia allow procedures such as lung volume reduction surgery and lung transplantation to be performed routinely. This paper reviews modern clinical practices in the field of thoracic anesthesia.

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