title: [Complicated anesthetic management for esophageal atresia repair in a baby with total anomalous pulmonary venous connection diagnosed after esophageal surgery].
abstract: A male newborn infant born at 38 weeks of gestation and weighing 2,660 g, was diagnosed as esophageal atresia. Although there was mild cyanosis at birth, his initial ultrasonographic examination performed by neonatologist showed normal anatomy of the heart. He underwent a surgical repair of esophageal atresia under general anesthesia. Anesthesia was induced with fentanyl and pancuronium, and maintained with sevoflurane and 60% oxygen. Frequent desaturation occurred during the procedure, requiring manual hyperventilation with 100% oxygen. Since blood pressure during the operation was unstable, volume loading with albumin was attempted. Further echocardiography was performed by pediatric cardiologist after going back to NICU. This revealed total anomalous pulmonary venous connection (TAPVC). He underwent cardiac surgery for repair of TAPVC on the next day. Although TAPVC was not preoperatively diagnosed regardless of results of echocardiogram, cyanosis and unstable blood pressure should be considered as signs of potential cardiac disease. Fluid restriction, higher hemoglobin, lower inspired oxygen and slightly higher carbon dioxide rather than albumin administration and hyperventilation should have been attempted during the esophageal repair.
authors: Department ofAnesthesiology, Okayama University Hospital, Okayama 700-8558.
authors: Aya
authors: A
authors: Sasaki
authors: Yuichiro
authors: Y
authors: Toda
authors: Mamoru
authors: M
authors: Takeuchi
authors: Tatsuo
authors: T
authors: Iwasaki
authors: Kazuyoshi
authors: K
authors: Shimizu
authors: Kiyoshi
authors: K
authors: Morita
mesh_terms: D000015:Abnormalities, Multiple; D000768:Anesthesia, General; D013504:Cardiovascular Surgical Procedures; D004452:Echocardiography; D004933:Esophageal Atresia / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D019990:Perioperative Care; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome