Cardiac arrest secondary to hyperkalemia during surgery for a neonatal giant sacrococcygeal teratoma

Reinoso-Barbero, Francisco; Sepulveda, Isabel; Pérez-Ferrer, Antonio; Andres, Anne De

doi:10.1111/j.1460-9592.2009.03049.x

Cited by 10 publications

(11 citation statements)

References 5 publications

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“…This patient was initially stable but by day 3 was requiring dopamine infusion. Even though the hyperkalemia was dangerous, she had no EKG changes, and in retrospect surgery could have proceeded with an intention to treat clinically significant hyperkalemia; however, cardiac arrest secondary to hyperkalemia has been reported in SCT resection [7]. The 2 days of management in the NICU to control the hyperkalemia produced little change in the potassium level but worsened her hemodynamic status due to the continuous hemorrhaging of the tumor.…”

Section: Discussionmentioning

confidence: 96%

Complications with massive sacrococcygeal tumor resection on a premature neonate

2010

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Resection of large sacrococcygeal teratomas (SCT) in neonates can pose many anesthetic challenges. The pathophysiology of the SCT determines the varying management. We present a case report of a 34-week newborn with a massive Altman type 3 SCT. The surgery was delayed 2 days because of hyperkalemia; however, as a result of continued tumor lysis the patient's condition had worsened with little improvement of the potassium level. During the surgery, the patient had issues of bleeding needing massive transfusion. Ventilation was also difficult at times because of the massive tumor resting on the chest, resulting in respiratory acidosis. We also had difficulty in maintaining the temperature. This patient did well after the surgery and was discharged home. We address here the anesthetic issues involved in the perioperative care management of a premature infant with a massive SCT.

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Section: Discussionmentioning

confidence: 96%

Complications with massive sacrococcygeal tumor resection on a premature neonate

2010

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“…Prevention of hyperkalemia was hardly possible, however, because of the sudden onset and fulminant course of the problem. In addition to hemolysis, tumor lysis might be another factor inducing hyperkalemia [6]. In our case, the tumor was manipulated carefully during operation to minimize tumor lysis.…”

Section: Discussionmentioning

confidence: 99%

Preoperative embolization of giant sacrococcygeal teratoma in a premature newborn

Lahdes-Vasama¹,

Korhonen²,

Seppänen³

et al. 2011

Journal of Pediatric Surgery

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“…Treatment for SCTs consists of surgical removal of the sacral mass [4]. Surgical resection should be performed immediately after birth as coagulopathy appears to worsen with time [6].…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of the coagulopathy associated with SCTs is unclear, but appears to be multifactorial, including prenatal diagnosis, polyhydroamniosis, large sized (> 10 cm) tumor, prematurity and hydrops fetalis [7]. Surgical removal of a SCT is a high risk procedure and requires careful anesthetic management [4]. …”

Section: Discussionmentioning

confidence: 99%

“…Large SCTs are associated with significant perinatal morbidity and mortality (5-50%) [3]. Treatment consists of surgical removal of the sacral mass, which has hypervascularity derived from the middle sacral artery [1], and is usually performed immediately after birth [4]. Therefore resection of these tumors is a high risk procedure, requiring careful anesthetic management [5].…”

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confidence: 99%

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Cardiac arrest during excision of a huge sacrococcygeal teratoma - A report of two cases -

Kim

Gwak

Park

et al. 2012

Korean J Anesthesiol

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Resection of large sacrococcygeal teratomas (SCTs) in premature neonates has been associated with significant perinatal mortality, making this a high risk procedure requiring careful anesthetic management. Most deaths during resection of SCTs are due to cardiac arrest caused by electrolyte imbalances, such as hyperkalemia, and massive bleeding during surgery. We describe two premature neonates who experienced cardiac arrest, one due to hyperkalemia and the other not due to hyperkalemia, during excision of large, prenatally diagnosed SCTs. We present here the considerations for anesthesia in premature neonates with huge SCTs.

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Cardiac arrest secondary to hyperkalemia during surgery for a neonatal giant sacrococcygeal teratoma

Cited by 10 publications

References 5 publications

Complications with massive sacrococcygeal tumor resection on a premature neonate

Complications with massive sacrococcygeal tumor resection on a premature neonate

Preoperative embolization of giant sacrococcygeal teratoma in a premature newborn

Cardiac arrest during excision of a huge sacrococcygeal teratoma - A report of two cases -

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