Professional paper

https://doi.org/10.26800/LV-142-1-2-6

Anesthesia of a child with open Botalli’s duct – a case report

Matija Majić ; Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, Medicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb
Dora Karmelić ; Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, Medicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb
Marin Mandić ; Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, Medicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb
Renata Curić Radivojević ; Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, Medicinski fakultet Sveučilišta u Zagrebu, Klinički bolnički centar Zagreb

Abstract

The 8-year-old boy was scheduled for an elective tonsillectomy because of a recurring middle ear infection, caused by adenoid hypertrophy. The patient had a patent ductus arteriosus (PDA), a common congenital
heart defect with a persistent communication between the aorta and the pulmonary artery. In this patient, there was only a haemodynamically insignificant left-to-right shunt. Current guidelines for anaesthetic management of patients with left-to-right shunt include: 1. Maintenance or decrease of systemic vascular resistance (SVR) as a haemodynamic goal; 2. Avoiding decreases in pulmonary vascular resistance (PVR); 3. Avoiding hyperoxia and hypocarbia. The preoperative assessment included collaboration with paediatric cardiologist who reevaluated the patient’s cardiac status, including a heart ultrasound and an ECG cardiography. The course of anaesthesia was uneventful. After neuromuscular blockade reversion and extubation, the patient was transferred to the post-anesthesia care unit (PACU) awake, haemodynamically stable and with satisfactory respiratory status.
The preoxygenation with 100% oxygen is a source of controversy. In a patient with PDA, a thorough preoperative evaluation of cardiac status and avoidance of worsening left-to-right shunt are essential for good outcome.

Keywords

DUCTUS ARTERIOSUS, PATENT – physiopathology; ANESTHESIA, GENERAL – methods; PULMONARY ARTERY – physiopathology; VASCULAR RESISTANCE; HEMODYNAMICS; OXYGEN; PERIOPERATIVE CARE; TONSILLECTOMY

Hrčak ID:

236609

URI

https://hrcak.srce.hr/236609

Publication date:

31.3.2020.

Article data in other languages: croatian

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