[Anesthetic management of a neonate with critical pulmonary valve stenosis for balloon pulmonary valvuloplasty].
We administered general anesthesia for balloon pulmonary valvuloplasty (BPV) to a 19 day-old male infant, weighing 2,789g, with critical pulmonary stenosis. The patient had severe cyanosis and mild right heart failure. Atropine (0.01 mg.kg-1) was administered intravenously immediately before induction of anesthesia. Pancuronium (0.4 mg) was used to facilitate endotracheal intubation and for the subsequent control of ventilation. Anesthesia was maintained with oxygen and enflurane (0.25 approximately 0.5%) supplemented with intravenous administration of fentanyl (1.5 micrograms.kg-1). During catheterization for balloon pulmonary valvuloplasty, SpO2 and blood pressure decreased temporarily to 35% and 50 mmHg, respectively. Several side effects of balloon inflation have been reported, such as bradycardia, arrhythmia, and the decrease in systemic blood pressure and arterial oxygen saturation, mainly due to the occlusion of pulmonary blood flow. Therefore, it might be recommended that BPV should be performed under stable state of general anesthesia with continuous monitorings of especially ECG, arterial blood pressure, central temperature, SpO2, ETCO2 and urine output.
Noguchi
R
R
Department of Anesthesiology, Niigata University School of Medicine.
Fujihara
H
H
Shimoji
K
K
D000768:Anesthesia, General / Q000379:methods*; D002404:Catheterization; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011666:Pulmonary Valve Stenosis / Q000628:therapy*