Anaesthetic management of bone marrow transplant recipients less than two years of age

Abstract

The charts and anaesthetic records of 97 infants less than two years of age who underwent bone marrow transplantation at the University of Minnesota from 1978-1992 were retrospectively reviewed. These infants underwent 564 general anaesthetics. There were 48 perioperative complications, most (39) involving the airway. There were 20 difficult intubations occurring in 13 patients. The causes of the difficult intubations were anatomical abnormalities (12), mucositis (4), pharyngeal oedema (3) and emesis upon induction of anaesthesia (1). Four intraoperative deaths occurred. The deaths were caused by haemorrhage (2), pulmonary embolism (1) and myocardial ischaemia (1). Four patients died within 72 h of surgery; one from cerebral oedema following an intraoperative cardiac arrest, one from fungal septicaemia, one from haemorrhage and one from multiple organ failure following an intracerebral haematoma. Infants undergoing bone marrow transplantation are at high risk for perioperative morbidity and mortality, particularly from complications involving the airway, bleeding or sepsis.

Upper Airway Complications in Children After Bone Marrow Transplantation

“… 9 These factors, when combined with the pulmonary sequelae frequently seen in BMT patients, put children at greater risk of airway compromise than adults. Beebe et al 10 described the anesthetic management of 97 pediatric BMT patients younger than 2 years of age, and the reasons for difficult intubations. The authors found that mucositis and anatomical abnormalities made intubation difficult in 13 patients.…”

Complications of anesthesia for children with malignant infantile osteopetrosis before and after hematopoietic stem cell transplantation

“…Before HSCT, patients receive anesthesia for procedures such as permanent central venous catheter placement, bone marrow aspiration, tracheostomy, and total body irradiation. Afterward, there are bone marrow biopsies to determine the success of HSCT and monitor for the development of graft‐versus‐host disease, radiological studies, and treatment of any surgical complications that arise (9). Although MIOP has adverse implications for anesthetic management (10), the literature describing the anesthetic management of MIOP patients is limited.…”