Respiratory management of pediatric patient with bronchiolitis obliterans syndrome during general anesthesia surgery: a case report.

Background: Bronchiolitis obliterans syndrome (BOS) is a rare but severe noninfectious pulmonary complication that typically arises in the context of chronic graft-versus-host disease (cGVHD) following allogeneic hematopoietic stem cell transplantation (HSCT). Characterized by progressive small airflow obstruction and irreversible airflow limitation, it poses significant challenges in managing general anesthesia, especially in pediatric patients. There is currently no established consensus or clinical research on the optimal anesthetic approach for such cases, making this report noteworthy. Case Description: We report the case of a 6-year-old boy with BOS and steroid-induced obesity who had undergone HSCT for acute lymphoblastic leukemia and required general anesthesia for cataract surgery. He had severely reduced lung function and hypercapnia. Anesthesia was induced with propofol, rocuronium, and remifentanil, and mechanical ventilation was managed using pressure-controlled ventilation-volume guaranteed (PCV-VG) mode to minimize airway pressures and prevent barotrauma. The surgery was completed without complications, and the patient was safely extubated and discharged the next day. Conclusions: This case demonstrates that the PCV-VG ventilation mode can be a viable option for managing pediatric patients with severe BOS undergoing general anesthesia. This approach can help achieve sufficient ventilation while minimizing airway pressures and the risk of ventilator-induced lung injury. This approach offers a viable anesthetic management option for similar cases in the future.