Anesthetic management of children with neuroblastoma.
OBJECTIVE
To review the 11-year anesthetic experience with neuroblastoma at Children's Hospital Medical Center, Boston, MA.


METHODS
Retrospective study.


METHODS
Children's Hospital, Boston, MA.


METHODS
59 consecutive children with neuroblastomas who underwent surgical procedures between 1977 and 1989.


METHODS
Symptoms, physical findings, laboratory data, and results of echocardiographic examination were recorded. Type of chemotherapy and urine catecholamine levels were noted. Intraoperative information was extracted about the surgical procedure, anesthetic technique, blood loss, and intraoperative vital sign changes. Postoperative data were reviewed for complications.


RESULTS
18 patients presented with a posterior mediastinal tumor. Five children presented with stridor, wheezing, pneumonia, and pleural effusion. Two children presented with hypertension. Left ventricular ejection fraction was within normal limits preoperatively in all patients evaluated by echocardiography. Intraoperative hypertension and tachycardia occurred in 3.5% of the children during tumor manipulation. No hypotension was noted following tumor removal. Of the 18 patients presenting with a posterior mediastinal mass, 3 had tracheal deviation caused by the tumor. The intraoperative course and extubation were uneventful in 2 of the patients, and the other patient remained intubated postoperatively. No adverse effect was identified for any particular anesthetic drug or technique used.


CONCLUSIONS
Although neuroblastomas may be associated with hypertension upon presentation, intraoperative hypertension is rare. Tracheal compression and deviation were noted in 5.2% of patients with posterior mediastinal masses; however, airway complications did not occur. No specific optimal anesthetic regimen can be recommended.
Kain
Z N
ZN
Department of Anesthesia and Surgery, Children's Hospital Medical Center, Boston, MA.
Shamberger
R S
RS
Holzman
R S
RS
D000008:Abdominal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D001794:Blood Pressure / Q000502:physiology; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D007223:Infant; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D016343:Monitoring, Intraoperative; D009447:Neuroblastoma / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013610:Tachycardia / Q000503:physiopathology