Anesthesiologist- and System-Related Risk Factors for Risk-Adjusted Pediatric Anesthesia-Related Cardiac Arrest.

Background: Pediatric anesthesia-related cardiac arrest (ARCA) is an uncommon but potentially preventable adverse event. Infants and children with more severe underlying disease are at highest risk. We aimed to identify system- and anesthesiologist-related risk factors for ARCA.

Immediate extubation after pediatric liver transplantation: a single-center experience.

The care of pediatric liver transplant recipients has traditionally included postoperative mechanical ventilation. In 2005, we started extubating children undergoing liver transplantation in the operating room according to standard criteria for extubation used for general surgery cases. We reviewed our single-center experience to determine our rates of immediate extubation and practice since that time.

Unilateral hemiparesis with thoracic epidural in an adolescent.

Objective. Unilateral sensory and motor blockade is known to occur with epidural anesthesia but is rarely reported in children. The differential diagnosis should include the presence of a midline epidural septum.

Malignant hyperthermia resolving with discontinuation of sevoflurane alone.

An otherwise healthy 13 year old developed hypercarbia and increased temperature during anesthesia with sevoflurane. Discontinuation of sevoflurane, surface cooling, and hyperventilation resulted in prompt resolution. However, hyperkalemia continued to raise the suspicion for malignant hyperthermia, which was ultimately confirmed by ryanodine receptor gene sequencing.

Exsanguination by intent: controlled phlebotomy during resection of a giant vascular malformation in a 22-month-old child.

Resection of large vascular malformations may require transection across the lesion, resulting in uncontrollable bleeding with the risk of exsanguination or massive transfusion-related complications such as hyperkalemic cardiac arrest. We present the anesthetic management of a 22-month-old child with a giant vascular malformation who required surgical intervention because of increasing pain and bleeding from the lesion. As a standard resection carried a high risk of mortality for the patient, a novel surgical approach was performed, consisting of gradual compression of the lesion, reducing its base to allow transection across the smallest possible area.

Anesthesia for patients undergoing transsternal thymectomy for juvenile myasthenia gravis.

Background: Juvenile myasthenia gravis (JMG) is the rare form of myasthenia gravis presenting in childhood and adolescence. When medical management fails, thymectomy is offered for these patients. Complete resection of the thymus is best achieved through transsternal thymectomy.

Tracheo-oesophageal fistula (TOF) and oesophageal atresia (OA).

Tracheo-oesophageal fistula (TOF) and oesophageal atresia (OA) represent a series of anatomical abnormalities presenting for emergency surgery in the neonatal period. They present the anaesthetist with cardio-respiratory challenges in the preoperative, intra-operative and postoperative phases. In addition to the consequences of the pathology itself, co-morbidities are very common, which superimpose further considerations.

Giant, dopamine secreting thoracoabdominal neuroblastoma in a 2-year-old: rapid preoperative blockade with labetalol.

Neuroblastomas secreting large amounts of catecholamines may require preoperative antihypertensive treatment to avoid intraoperative hypertensive crises as do pheochromocytomas. This is typically achieved with alpha-adrenergic followed if necessary by beta-adrenergic receptor blockade. Because of its predominant beta-blockade, labetalol as a combined alpha-adrenergic and beta-adrenergic receptor antagonist is relatively contraindicated as sole and first agent in pheochromocytomas releasing epinephrine and norepinephrine.

Catecholamine-secreting neuroblastoma in a 4-month-old infant: perioperative management.

Preoperative alpha- and beta-adrenergic receptor block with phenoxybenzamine and labetalol, the intraoperative course of a 4-month-old infant with neuroblastoma and elevated catecholamines causing sweating, hypertension, and tachycardia, are presented. We recommend determination of catecholamine levels and pretreatment with alpha-adrenergic and--if needed--beta-adrenergic receptor antagonists in infants with neuroblastoma and hypertension, tachycardia, or sweating.