A rare anaesthetic challenge in a one-lung ventilated paediatric patient with right upper lobe tracheal bronchus.

A tracheal bronchus is a rare congenital anomaly, suggesting abnormal bronchial development. The prevalence of tracheal bronchus in children who undergo bronchoscopy is estimated to be between 0.2% and 3%. When associated with recurrent infection, lobes of the lung must be removed to avoid further lung injury. In such cases, perioperative one-lung ventilation and airway management remain a huge challenge for anaesthesiologists. The case of this rare airway anatomic abnormality in a paediatric patient with two bronchial openings into the right upper lobe, and with a history of recurrent pneumonia, is reported. In addition to a normal opening, a distinct opening in the upper lobe of the right lung was observed, that originated directly from the trachea, superior to the carina. The entire right lung was deflated by left-lung ventilation using a single lumen tracheal tube, and the patient underwent right upper lobe resection. No anaesthesia complications were observed during recovery. In this case, timely identification of the tracheal bronchus and successful collapse of the right lung were key points in the anaesthesia management of this patient.

Functional Modular Network Identifies the Key Genes of Preoperative Inhalation Anesthesia and Intravenous Anesthesia in Off-Pump Coronary Artery Bypass Grafting.

Off-pump coronary artery bypass grafting (OPCABG) is an effective strategy for revascularization. Preoperative anesthesia appears critical due to surgical instability and the risk of organ damage. This study, based on a functional module network, analysed the effects of preoperative inhalation anesthesia and intravenous anesthesia on OPCABG and performed a pivot analysis of its potential drug regulators. We obtained microarray data of sevoflurane anesthesia and propofol anesthesia from the GEO database and analysed the difference between the two groups of data, resulting in 5701 and 3210 differential genes to construct the expression matrix. WGCNA analysis showed that sevoflurane anesthesia clustered into 7 functional disorder modules, including PDCD6IP, WDR3, and other core genes; propofol anesthesia clustered to form two functional disorder modules, including KCNB2 and LHX2, two core genes Enrichment analysis of the functions and pathways of interest suggests that both anesthesia-related module genes tend to function as pathways associated with ion and transmembrane transport. The underlying mechanism may be that targeted regulation of transmembrane-associated biological processes and ion pathways in the core genes of each module affect the surgical process. Pivot analysis of potential drug regulators revealed 229 potential drugs for sevoflurane anesthesia surgery, among which zinc regulates three functional disorder modules via AHSG, F12, etc., and 67 potential drugs for propofol anesthesia surgery, among which are propofol, methadone, and buprenorphine, regulate two functional disorder modules through four genes, CYP2C8, OPRM1, CYP2C18, and CYP2C19. This study provides guidance on clinical use or treatment by comparing the effects of two anesthesias on surgery and its potential drugs.