Anesthetic management of a patient with Kasabach-Merritt syndrome

Kasabach-Merritt syndrome presents various problems for anesthetic management, which include thrombocytopenia, bleeding tendency, and problems arising from the hemangioma mass itself. A 20-month-old female was scheduled for cryosurgery of a hemangioma on the face. Massive bleeding from the tumor was easily induced even by slight contact. The hematologic examination revealed a low platelet count and anemia. Anesthesia was induced carefully by applying an adult anesthetic mask to avoid the large tumor mass on the face and maintained with halothane and nitrous oxide/oxygen. Additional doses of prednisolone were administered before and during anesthesia to compensate for possible adrenal insufficiency due to steroid therapy which she had been receiving. Neither excessive bleeding nor any other particular complications occurred during anesthesia and surgery, and the postoperative course was also uneventful.