Congenital obstruction of the upper airway (CHAOS) is CASE REPORTA 27-year-old woman, gravida 2, para 1, was referred to our institution at 31 weeks of gestation. Previous ultrasound findings at 17, 20 and 23 weeks were interpreted as suggestive of bilateral congenital cystic adenomatoid malformation (CAM) of the lung, Type III. Both lungs were hyperechoic, with the mediastinum shifted to the midline, diaphragm flattened, and the heart appearing compressed (Figures 1 and 2). In addition, an elongated hypoechoic structure in the posterior mediastinum was identified and thought to represent the fluid-filled esophagus (Figure 3). Polyhydramnios and a single umbilical artery were also detected. The patient underwent genetic counseling and amniocentesis, which revealed a normal male karyotype. Ultrafast fetal magnetic resonance imaging performed at 24 weeks showed a grossly normal fetal chest (sequences after balanced fast field-echo localizers consisted primarily of T2-weighted single-shot imaging with additional fast field-echo images).The initial ultrasound scan at our facility at 31 weeks revealed normal echogenicity of the lungs, and the previously described elongated hypoechoic structure in the posterior mediastinum was no longer detectable. Amniotic fluid volume was normal by 32 weeks of gestation, when pectus excavatum and right ventricular enlargement were also noted. Fetal echocardiography confirmed right ventricular enlargement and suspected pulmonary hypertension. A repeat ultrasound scan at 35 weeks yielded no additional relevant information. Biometry indicated appropriate fetal growth, with an estimated fetal weight at the 39th percentile for dates.The mother had no significant personal or family history. The current pregnancy was complicated by dietcontrolled gestational diabetes and late-onset gestational hypertension. She was admitted for labor induction at 38 weeks of gestation after spontaneous rupture of membranes. Ten hours after admission, a nonreassuring fetal heart rate pattern necessitated a primary low-transverse Cesarean delivery under lumbar epidural anesthesia. A liveborn male infant weighing 2655 g

The CobraPLA airway performed as well as the LMAU during anesthesia in pediatric patients for a large range of outcomes and was superior for some.

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This investigation demonstrates that a computerized injection pump can be used to identify the epidural space and can serve as a base for further comparative research to determine whether this technology can increase the success rate of EA or lower the incidence of side effects.

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