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[Adeno-tonsillectomy after cardiac transplantation in a child]
T Suzuki1, K Hirayama, Y Kondo
1Department of Anesthesia and ICU, National Children's Hospital, Tokyo.
Insights
This case report details a heart transplant recipient who underwent adenoidectomy and tonsillectomy. Anesthesia was uneventful, improving upper airway obstruction and patient weight gain.
Area of Science:
- Pediatric Anesthesiology
- Cardiology
- Otolaryngology
Background:
- Children with prior heart transplants present unique anesthetic challenges.
- Upper airway obstruction from enlarged adenoids/tonsils can cause severe hypoxemia and failure to thrive in these patients.
Observation:
- A one-year-old heart transplant recipient experienced severe episodic hypoxemia and poor weight gain due to adenotonsillar hypertrophy.
- The child was otherwise active with no signs of congestive heart failure.
Findings:
- Anesthesia for adenoidectomy and tonsillectomy was successfully managed with balanced anesthesia, maintaining hemodynamic stability.
- Post-operative improvement in upper airway obstruction was confirmed by respiratory inductive plethysmography.
- Perioperative management of immunosuppression (cyclosporine) required careful monitoring due to unavailability of IV preparations.
Implications:
- This case highlights the safety and feasibility of non-cardiac surgery in pediatric heart transplant recipients.
- Careful perioperative management is crucial for optimizing outcomes in this vulnerable population.
- Further research into anesthetic protocols and immunosuppression management for these patients is warranted.
Abstract:
A case report of a boy who had a heart transplant at age one, and an adeno-tonsillectomy at age 2 years and 2 months, is presented. The patient showed severe episodic hypoxemia and poor weight gain (below 3 SD) due to upper airway obstruction caused by enlarged adenoids and tonsils. He was very active and no signs of congestive heart failure were noted. General anesthesia was induced with thiopental and maintained with a balanced anesthesia of nitrous oxide, oxygen, fentanyl, and vecuronium bromide. The heart rate did not increase with endotracheal intubation nor adenoidectomy but heart rate and blood pressure did increase slowly by the time the tonsillectomy was performed. Arrhythmia did not appear throughout the procedure and anesthesia was uneventful. A nasal endotracheal tube was kept in place for 4 days until surgical edema subsided. Respiratory inductive plethysmography performed before surgery and 2 days after extubation showed improvement of upper airway obstruction. The patient's blood concentration of cyclosporine fell briefly below the optimal level perioperatively due to unavailability of intravenous preparation in Japan. Various aspects of non-cardiac anesthesia for children who have experienced cardiac transplants are discussed.