RESUMEN
A 21-month-old patient diagnosed as 18 trisomy, having large ventricular septal defect with pulmonary valve stenosis, and gastroesophageal reflux disease, was admitted for laparoscopic Nissen fundoplication and gastrostomy. Anesthesia was induced with midazolam, fentanyl, and rocuronium, and maintained with sevoflurane and remifentanil. After induction of anesthesia, oxygenation became worse, possibly due to diminished pulmonary blood flow, which was partially resolved with vasopressor administration and fluid infusion. After the abdomen was insufflated, oxygenation improved significantly. We supposed that an increase in systemic vascular resistance due to O2 insufflation augmented pulmonary blood flow and improved the oxygenation. She was extubated the next day and recovered uneventfully. However, we should bear in mind that 18 trisomy patients are frequently complicated by congestive heart disease, and require caution for hemodynamic changes during anesthesia.
Asunto(s)
Anestesia General/métodos , Fundoplicación , Insuficiencia Cardíaca/complicaciones , Trisomía , Cromosomas Humanos Par 18 , Femenino , Reflujo Gastroesofágico/cirugía , Gastrostomía , Defectos del Tabique Interventricular/complicaciones , Humanos , Lactante , Estenosis de la Válvula Pulmonar/cirugíaRESUMEN
We recently encountered three cases of the leakage from the connecting portion of sevoflurane vaporizer in Fabius Tiro produced by Drager company, and in one case of those, oxygen saturation decreased. The connecting portion had leakage merely in the contact with the fixture of the monitor, because of the structure easily displaced by an external force. Further, it was difficult to detect the leakage due to the ability to correct the insufficient supply of fresh gas by taking in air. We hope a reform of the connecting portion and an alarm to inform it if the anesthesia machine detects the leakage.