Congenital Lobar Emphysema: Diagnosis and Management: REPLY

I thank the author for his interest in my article and his valuable comments. While it is true that only histopathology can differentiate between congenital and acquired form of emphysema, it is only of academic interest as it has no bearing on the management. There was no doubt regarding diagnosis in both the cases, as there were several pointers towards the congenital origin of the entity. Not only did the infants become symptomatic at an early age, the duration of symptoms were too short to explain acquired etiology. The omission was deliberate as the focus of the report was on the anaesthetic issues. Prenatal ultrasonography has proved to be useful in diagnosis of many congenital lesions, let alone lung lesions. As for involvement of a “paediatrician skilled in neonatal care and ventilation” during anaesthetic management, it will be sufficient to mention that similar degree of skills are available inside the operation theater when these cases are managed by a paediatric anaesthesiologist. Hypothermia is an invariable accompaniment of prolonged surgeries, especially those which involve opening of body cavities such as thorax and abdomen. All the preventive measures are taken routinely for such cases and the important point is to recognize its occurance and intervene accordingly.