RESUMO
A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.
Assuntos
Criança , Feminino , Humanos , Lactente , Anestesia Geral , Reanimação Cardiopulmonar , Cateterismo , Catéteres , Cateteres Venosos Centrais , Tratamento Farmacológico , Transplante de Células-Tronco Hematopoéticas , Pediatria , Leucemia-Linfoma Linfoblástico de Células Precursoras , Circulação Pulmonar , Embolia Pulmonar , Veia Subclávia , TromboseRESUMO
A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.
Assuntos
Criança , Feminino , Humanos , Lactente , Anestesia Geral , Reanimação Cardiopulmonar , Cateterismo , Catéteres , Cateteres Venosos Centrais , Tratamento Farmacológico , Transplante de Células-Tronco Hematopoéticas , Pediatria , Leucemia-Linfoma Linfoblástico de Células Precursoras , Circulação Pulmonar , Embolia Pulmonar , Veia Subclávia , TromboseRESUMO
Tension pneumothorax (PTx) was diagnosed in a preterm baby during surgery for tracheoesophageal fistula (TEF). The PTx occurred around 90 minutes after skin incision, while the baby was breathing spontaneously with intermittent positive pressure ventilation (PPV) at low pressure. A sudden decrease in oxygen saturation (SpO2), hemodynamic compromise, and decreased breath sounds on the right side suggested a right-sided tension PTx. After prompt radiological confirmation, needle aspiration of air through the surgical site restored the patient's condition immediately. Although the sudden unexpected hypoxemia and circulatory problems may confuse anesthesiologists, prompt diagnosis and proper treatment are required for successful clinical outcomes in tension PTx.