title: [Adeno-tonsillectomy after cardiac transplantation in a child].
abstract: A case report of a boy who had a heart transplant at age one, and an adeno-tonsillectomy at age 2 years and 2 months, is presented. The patient showed severe episodic hypoxemia and poor weight gain (below 3 SD) due to upper airway obstruction caused by enlarged adenoids and tonsils. He was very active and no signs of congestive heart failure were noted. General anesthesia was induced with thiopental and maintained with a balanced anesthesia of nitrous oxide, oxygen, fentanyl, and vecuronium bromide. The heart rate did not increase with endotracheal intubation nor adenoidectomy but heart rate and blood pressure did increase slowly by the time the tonsillectomy was performed. Arrhythmia did not appear throughout the procedure and anesthesia was uneventful. A nasal endotracheal tube was kept in place for 4 days until surgical edema subsided. Respiratory inductive plethysmography performed before surgery and 2 days after extubation showed improvement of upper airway obstruction. The patient's blood concentration of cyclosporine fell briefly below the optimal level perioperatively due to unavailability of intravenous preparation in Japan. Various aspects of non-cardiac anesthesia for children who have experienced cardiac transplants are discussed.
authors.affiliation: Department of Anesthesia and ICU, National Children's Hospital, Tokyo.
authors.forename: T
authors.initials: T
authors.lastname: Suzuki
authors.forename: K
authors.initials: K
authors.lastname: Hirayama
authors.forename: Y
authors.initials: Y
authors.lastname: Kondo
authors.forename: H
authors.initials: H
authors.lastname: Sakai
authors.forename: K
authors.initials: K
authors.lastname: Miyasaka
mesh_terms: D000768:Anesthesia, General / Q000379:methods*; D002675:Child, Preschool; D016572:Cyclosporine / Q000097:blood; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D014068:Tonsillectomy
chemical_list: D016572:Cyclosporine