[Anesthetic management of an 18-trisomy neonate with high frequency ventilation]

Area of Science:

• Anesthesiology
• Neonatology
• Medical Genetics

Background:

• Trisomy 18 syndrome (Edwards syndrome) is associated with significant congenital anomalies and historically poor one-year survival rates (<10%).
• Active treatment is often not recommended due to these low survival rates.
• Improved survival rates have been observed in some centers, necessitating effective anesthetic strategies for surgical interventions.

Observation:

• A male neonate diagnosed with trisomy 18 syndrome presented for immediate radical repair of an umbilical hernia.
• The neonate exhibited difficult tracheal intubation due to airway anomalies (cleft lip, cleft palate, macrognathia) and facial dysmorphism.
• Conventional ventilation proved insufficient for adequate carbon dioxide elimination and oxygenation, complicated by pulmonary hypoplasia and intracardiac shunts.

Findings:

• High-frequency ventilation was employed as an alternative anesthetic technique.
• This ventilation strategy significantly improved both carbon dioxide elimination and oxygenation in the neonate.
• The patient survived beyond five years, indicating the potential efficacy of tailored anesthetic management.

Implications:

• This case highlights the feasibility and benefits of advanced anesthetic techniques, such as high-frequency ventilation, in neonates with trisomy 18 syndrome.
• It suggests that improved survival rates may be achievable with appropriate perioperative care and ventilation strategies.
• Further research into anesthetic management protocols for trisomy 18 neonates undergoing surgery is warranted.