Abstract
Background: Double outlet right ventricle (DORV) is an uncommon congenital heart defect characterized by the simultaneous emergence of both the aorta and pulmonary artery from the right ventricle. This condition is frequently linked with other congenital anomalies, such as imperforate anus, which presents considerable challenges for anesthesiologists. This case report outlines the effective anesthetic management of a preterm neonate diagnosed with DORV and imperforate anus, who was scheduled for an urgent sigmoid colostomy.
Case presentation: A 6-day-old preterm female weighing 2.2 kg, exhibited DORV along with a subaortic ventricular septal defect, mild pulmonary stenosis, adequate biventricular function, and moderate pulmonary hypertension. Additionally, she presented with an imperforate anus accompanied by a recto-vaginal fistula. The preoperative assessment involved echocardiography, electrocardiography, and various laboratory tests. The pediatric cardiologist advised that the patient's oxygen saturation should be maintained within the range of 80-85% throughout the emergency colostomy procedure. Anesthetic management involved premedication with glycopyrrolate, ondansetron, fentanyl, and dexamethasone. The patient was induced with sevoflurane and intubated with a 2 mm endotracheal tube. Anesthesia was maintained with a mixture of air and oxygen, sevoflurane, and atracurium. Hypothermia was prevented using a warmer, and fluid management was guided by the patient's hemodynamic parameters. After the 1-hour surgery, the patient was transferred to the neonatal intensive care unit, where she was initially supported with synchronized intermittent mandatory ventilation and later extubated
Conclusion: The effective anesthetic management of this preterm neonate with DORV and imperforate anus necessitated a comprehensive understanding of the associated cardiac and anorectal anomalies, meticulous preoperative planning, and a collaborative multidisciplinary approach to perioperative care. The anesthesiologist was instrumental in ensuring the patient's safety and enhancing the surgical conditions throughout the emergency colostomy procedure.
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References
- Bell-Cheddar Y, Devine WA, Diaz-Castrillon CE, Seese L, Castro-Medina M, Morales R, Follansbee CW, Alsaied T, Lin JHI. Double outlet right ventricle. Frontiers in Pediatrics [Internet]. 2023 Sep 25;11. Available from: https://doi.org/10.3389/fped.2023.1244558
- Karmegaraj B, Kumar S, Srimurugan B, Sudhakar A, Simpson JM, Vaidyanathan B. 3D / 4D spatiotemporal image correlation ( STIC ) fetal echocardiography provides incremental benefit over 2D fetal echocardiography in predicting postnatal surgical approach in double‐outlet right ventricle. Ultrasound in Obstetrics and Gynecology [Internet]. 2020 Feb 5;57(3):423–430. Available from: https://doi.org/10.1002/uog.21988
- Double outlet right ventricle : MedlinePlus Medical Encyclopedia [Internet]. Available from: https://medlineplus.gov/ency/article/007328.htm
- Khatib N, Belossesky R, Marwan O, Weiner Z. Fetal bowel calcifications: A sign of anal atresia with rectourethral fistula. Journal of Clinical Ultrasound [Internet]. 2010 Apr 29;38(6):332–334. Available from: https://doi.org/10.1002/jcu.20706
- Eftaiha SM, Melich G, Pai A, Marecik SJ, Prasad LM, Park JJ. Sacral nerve stimulation in the treatment of bowel dysfunction from imperforate anus: A case report. International Journal of Surgery Case Reports [Internet]. 2016 Jan 1;24:115–118. Available from: https://doi.org/10.1016/j.ijscr.2016.05.018
- Nursing guidelines : Oxygen saturation SpO2 level targeting in neonates [Internet]. Available from: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index /oxygen_saturation_spo2_level_targeting_premature_neonates/
- Kim CY, Kim WH, Kwak JG, Jang WS, Lee CH, Kim DJ, Lim C, Chang WI. Surgical Management of Left Ventricular Outflow Tract Obstruction after Biventricular Repair of Double Outlet Right Ventricle. Journal of Korean Medical Science [Internet]. 2010 Jan 1;25(3):374. Available from: https://doi.org/10.3346/jkms.2010.25.3.374
- Spaeth JP. Perioperative Management of DORV. Seminars in Cardiothoracic and Vascular Anesthesia [Internet]. 2014 Mar 21;18(3):281–289. Available from: https://doi.org/10.1177/1089253214528048
- McClung H, Prasad R, Schwartz R. Anesthetic management of tracheoesophageal fistula repair in a newborn with a double-outlet right ventricle. Journal of Clinical Anesthesia [Internet]. 2011 Dec 1;23(8):643–645. Available from: https://doi.org/10.1016/j.jclinane.2011.01.010
- Singh A, Garg K, Ganesh V, B NN, Singh D. Anaesthesia challenges in a neonate having supracardiac total anomalous pulmonary venous return with incidental stridor for non-operating room anaesthesia (NORA): feed and wrap technique as a rescue. Cureus [Internet]. 2022 Oct 16; Available from: https://doi.org/10.7759/cureus.30357
- Sinha R, Talawar P, Ramachandran R, Azad R, Mohan V. Perioperative management and post-operative course in preterm infants undergoing vitreo-retinal surgery for retinopathy of prematurity: A retrospective study. Journal of Anaesthesiology Clinical Pharmacology [Internet]. 2014 Jan 1;30(2):258. Available from: https://doi.org/10.4103/0970-9185.130050
- Liu H, Wang F, Zhang J, Gao Z. Risk factors for anesthesia-associated postoperative capillary leakage after thoracoscopic surgery in neonates: A single-center observational study. Frontiers in Pediatrics [Internet]. 2023 Jan 4;10. Available from: https://doi.org/10.3389/fped.2022.1051069
