Agenesis of the lung is a rare developmental defect characterized by complete absence of one lung, or hypoplasia of one or both lungs. The majority of reported cases have been associated with other congenital anomalies. It is usually detected in childhood as a result of either pulmonary symptoms or associated anomalies. Although
pulmonary agenesis has been reported in adults, there is no report of the management of a pregnant patient for
cesarean section in the
anesthetic literature. We report the management of a 23-year-old pregnant female at 36 weeks' gestation with
oligohydramnios and left
lung agenesis for elective
cesarean section. She presented with a history of repeated chest
infection and was found to have restrictive lung function. She had no other congenital anomalies. Combined spinal
epidural anesthesia was administered for
cesarean section. The intraoperative course was uneventful except for
bradyarrhythmias followed by
tachyarrhythmias on manipulation of the uterus. She was given low dose epidural
morphine with
local anesthetic and intramuscular
diclofenac for postoperative
analgesia. We believe that normal pregnancy can safely be undertaken in the presence of left
lung agenesis. In view of associated congenital anomalies in more than 50% of the cases,
anesthetic management should include a particularly careful survey of other systems. The patient should otherwise be managed like any patient with limited pulmonary reserve. Combined spinal
epidural anesthesia is safe and appropriate for such patients.