Anesthetic management of a pediatric patient with severe Williams-Campbell syndrome undergoing surgery for giant ovarian tumor

Abstract

We performed anesthetic management for a patient with severe Williams-Campbell syndrome, which is a congenital deficiency of cartilage in the subsegmental bronchial tree. An 11-year-old girl with this syndrome had labored breathing because of abdominal distension caused by a giant ovarian tumor, and removal of the tumor was scheduled. Because she had been receiving home oxygen therapy for 10 years due to hypoxia, it was possible that positive-pressure ventilation may have increased the risk of perioperative pulmonary complications. So we selected combined spinal and epidural anesthesia with general anesthesia, using a ProSeal (Laryngeal Mask Company, Henley on Thames, UK) laryngeal mask airway. We placed an epidural catheter and induced spinal anesthesia blockade under general anesthesia as the main analgesia technique, in order to maintain spontaneous breathing. The surgery was completed uneventfully and the patient emerged from anesthesia without dyspnea. She had an uneventful recovery and was discharged home.

The ProSealTM LMA Offers Protection against Regurgitation in Emergency Abdominal Laparoscopic Surgery

“…The limits of performance and security of the PLMA in this scenario remain undefined. Cadaver and clinical studies have confirmed that when the drainage tube is correctly positioned, the PLMA provides protection from fluid regurgitation [3,4]. Notably, PLMA design and function minimizes the likelihood of regurgitation and aspiration, and extensive evidence supports this [2].…”

Combined spinal and epidural anesthesia in a child with epidermolysis bullosa

“…CSE is a recognized technique in such age and with compromised airway. CSE administration was reported (4,5) for children with acute tracheobronchial injury and rare syndromes, because of associated compromised airway that precluded administration of general anesthesia, as it combines the benefit of a sure onset of a heavy block and limitless anesthesia, besides free airway. Sedation is needed with pediatric regional anesthesia especially with EB to keep children in a quiet state, as struggling may result in trauma and blistering.…”