Anesthetic management of a newborn with trisomy 18 undergoing closure of patent ductus arteriosus and pulmonary artery banding : case report

Abstract

Our knowledge of the proper anaesthetic technique for children undergoing palliative or corrective surgery is limited. Further case reports will increase our experience in peri-operative management of children with trisomy 18.

Anesthetic management of a patient with Edwards syndrome

“…Arun et al 2, report using an inhalational induction due to problems with securing venous access in their management of a 13‐day‐old girl with trisomy 18 undergoing closure of a PDA and pulmonary artery banding. However, they reported an uneventful and regular duration of induction with sevoflurane.…”

“…Structural heart defects occur in over 90% of infants with Edwards syndrome. The most common cardiac lesions are atrial and ventricular septal defects (ASD), VSD, PDA, and polyvalvular disease [2]. Courreges, et al [7] in their management of a 7-year-old girl with Edwards syndrome undergoing a Cohen procedure, suggest that these patients can be considered as cardiac patients.…”

“…Thus, it is imperative that hypercapnia and hypoxia are prevented in pulmonary hypertension to avoid potential reversal of the bidirectional shunt. Other anesthetic considerations are maintenance of hemodynamic stability and homeostasis between systemic and pulmonary circulations [2]. The use of volatile inhalational agents with the least cardiac depressant effects, such as sevoflurane, is the sensible option.…”

“…Courreges et al [7] performed an inhalational induction with sevoflurane which took longer (8 minutes) than usual but this was attributed to a change in ventilation/perfusion ratio caused by the cardiac disease. Arun et al [2], report using an inhalational induction due to problems with securing venous access in their management of a 13-dayold girl with trisomy 18 undergoing closure of a PDA and pulmonary artery banding. However, they reported an uneventful and regular duration of induction with sevoflurane.…”

“…It consists of craniofacial anomalies, visceral defects, and delayed mental and motor development. The survival rate beyond the first year of life is 5-10%, with a live-birth prevalence estimated at 1:3,600-10,500 [2]. In Malta, the estimated prevalence is 3.26 per 10,000 births [3].…”