Pulmonary Embolism During Hepatoblastoma Resection

Area of Science:

• Pediatric Oncology
• Surgical Complications
• Anesthesiology

Background:

• Hepatoblastoma, a rare but malignant childhood tumor, is treated with surgery and chemotherapy.
• Hepatic resection, while crucial, carries risks such as potentially fatal pulmonary embolism.
• Monitoring patient vitals during surgery is critical for timely intervention.

Observation:

• A 9-month-old patient undergoing hepatectomy post-chemotherapy experienced a sudden drop in end-tidal CO2 (ETCO2).
• This was followed by arrhythmia, bradycardia, and cardiac arrest despite cardiopulmonary resuscitation (CPR).
• Non-invasive monitoring tools like perfusion index (PI), plethysmographic variability index (PVI), and non-invasive total hemoglobin (SpHb) were utilized.

Findings:

• The patient did not respond to CPR, indicating a severe intraoperative event.
• The rapid decline suggests a critical circulatory or respiratory compromise.
• The study emphasizes the potential for fatal complications during pediatric liver surgery.

Implications:

• Consideration of prophylactic anticoagulation, such as heparin, may mitigate thrombosis risk in liver surgery patients.
• Enhanced vigilance and advanced non-invasive monitoring are crucial for early detection of critical events.
• Further research into anesthetic management and thromboprophylaxis in pediatric hepatectomy is warranted.