Anesthesia for thoracic surgery in infants with congenital lung malformations

Congenital lung malformations (CLMs) are disorders arising from defective embryonic development of the airways, lung parenchyma, and pulmonary vasculature, often presenting as heterogeneous lesions like congenital pulmonary airway malformation (CPAM), pulmonary sequestration (PS), and congenital lobar overinflation (CLO). CLMs in infants present unique anesthetic challenges —particularly the risk of progressive distention in cystic areas and the anatomical difficulty of achieving stable lung isolation— but institutional rarity limits clinical experience and consensus-driven practices. This review examines recent clinical anesthesia practices for infants with CLMs undergoing thoracic surgery, offering comprehensive guidance on perioperative anesthesia management, with an emphasis on ventilation management. Crucially, we evaluate the selection and precise positioning of lung isolation devices, such as left endobronchial intubation and bronchial blockers. Furthermore, it provides a structured management strategy for intraoperative hypoxemia and outlines lung-protective ventilation frameworks—incorporating low tidal volumes and personalized PEEP—to consolidate contemporary evidence and optimize the perioperative anesthetic approach for this vulnerable population.